• Clazosentan Reduced Vasospasm-Related Morbidity but Did Not Improve aSAH Neurological Outcomes

    Cerebral vasospasm secondary to aneurysmal subarachnoid hemorrhages (aSAH) causes significant cause of morbidity and mortality. Clazosentan is an endothelin receptor antagonist that inhibits endothelin-mediated vasoconstriction, and is being tested clinically for preventing vasospasm. A meta-analysis by Shen et al (J. Neurosurgery, July 2013) of 4 randomized placebo-controlled trials enrolling 2181 patients examines clazosentan’s effect on vasospasm-related morbidity and mortality, and drug-related adverse events in aSAH. These 4 randomized trials showed substantial variation in results. However, the meta-analysis showed that clazosentan treatment after aSAH significantly reduced the incidence of vasospasm-related neurological deficits and delayed cerebral infarctions, but failed to improve poor neurological outcomes. This dissociation between vasospasm-related morbidity and clinical outcomes associated with clazosentan therapy remains unclear and requires further investigation.


    Journal of Neurosurgery

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