Impact of Clazosentan Use on Symptomatic Vasospasm and Early Ambulation in Patients with Aneurysmal Subarachnoid Hemorrhage: A Retrospective Cohort Study

This retrospective cohort study investigated the association between the use of clazosentan and the incidence of symptomatic vasospasm, as well as rehabilitation-related outcomes, particularly, the timing of ambulation, in patients with aneurysmal subarachnoid hemorrhage. A total of 153 patients who underwent surgical clipping or endovascular coiling at our institution between January 2020 and March 2025 were included; among them, 76 received clazosentan, and 77 received conventional treatment.The primary outcomes were the incidence of symptomatic vasospasm and the number of days to initial ambulation. Secondary outcomes included changes in body weight, peripheral oxygen saturation, and laboratory parameters one week after drug administration.The incidence of symptomatic vasospasm was significantly lower in the clazosentan group (5.3%) than in the conventional treatment group (20.7%) (p = 0.007). In addition, ambulation was achieved significantly earlier in the clazosentan group (median: 8.5 days; interquartile range: 5-12) than in the control group (median: 11 days, interquartile range: 8-15) (p = 0.015).Conversely, one week after administration, the clazosentan group showed a significant increase in body weight and significant decreases in peripheral oxygen saturation, serum albumin, hemoglobin, and hematocrit levels, suggesting potential systemic effects.These findings suggest that clazosentan use may be associated with a lower incidence of symptomatic vasospasm and earlier ambulation in patients with aneurysmal subarachnoid hemorrhage; however, careful monitoring of systemic status is warranted during rehabilitation.