Key result
Adding clazosentan to fasudil is linked to increased relative cerebral blood volume vs fasudil alone.
Why the study?
The effects of clazosentan on cerebral microcirculation after aneurysmal subarachnoid hemorrhage remain unclear.
Does the addition of clazosentan to fasudil improve cerebral perfusion metrics in patients with aneurysmal subarachnoid hemorrhage?
Cohort (n=67)
Does the addition of clazosentan to fasudil improve cerebral perfusion metrics in patients with aneurysmal subarachnoid hemorrhage?
Mean Difference: 0.172
p-value: p=0.008
Adding clazosentan to fasudil in patients with aneurysmal subarachnoid hemorrhage increases cerebral blood volume but does not improve cerebral blood flow or 3-month functional outcomes.
Clazosentan was associated with higher rCBV in this small observational cohort; hypothesis-generating and should not change practice pending randomized data.
OBJECTIVE: Clazosentan, an endothelin receptor antagonist, is used to prevent cerebral vasospasm after aneurysmal subarachnoid hemorrhage; however, its effects on the cerebral microcirculation remain unclear. This study evaluated clazosentan-associated hemodynamic changes using computed tomography perfusion (CTP). METHODS: We retrospectively analyzed 67 patients with aneurysmal subarachnoid hemorrhage treated between January 2020 and March 2025. Patients received either fasudil alone or fasudil plus clazosentan. Relative cerebral blood flow, relative cerebral blood volume (rCBV), and relative mean transit time were calculated from serial CTP examinations. A linear mixed-effects model included patient ID as a random effect and treatment group, number of CTP examinations, brain region, age, treatment modality, and radiographic vasospasm as fixed effects. RESULTS: A total of 98 follow-up CTP examinations were analyzed. rCBV was significantly higher in the fasudil + clazosentan group in both the peripheral cortical and basal ganglia regions, whereas no significant between-group differences were observed in relative cerebral blood flow or relative mean transit time. In the mixed-effects model, the addition of clazosentan remained significantly associated with increased rCBV (estimated difference = 0.172, P = 0.008). No significant interactions with brain region or number of CTP examinations were observed. rCBV was not significantly associated with a favorable functional outcome at 3 months (P = 0.092). CONCLUSIONS: The addition of clazosentan to fasudil was associated with increased cerebral blood volume, without significant changes in cerebral blood flow or mean transit time. These findings may be consistent with altered microvascular capacitance but should not be interpreted as evidence of improved tissue perfusion or clinical outcomes.
No takes yet. Share an insight, caveat, or question.
Nishiyama et al. (2026) conducted a cohort in Aneurysmal subarachnoid hemorrhage (n=67). Fasudil plus clazosentan vs. Fasudil alone was evaluated on Relative cerebral blood volume (rCBV) (estimated difference 0.172, p=0.008). The addition of clazosentan to fasudil was significantly associated with increased relative cerebral blood volume compared to fasudil alone (estimated difference = 0.172; P = 0.008).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: