Hidaka Toshikazu, Ochiai Junichiro, Inoue Yusuke, Kawamoto Yuichiro, Horie Nobutaka, Nishikawa Yusuke, Mase Mitsuhito, Morioka Motohiro, Takahashi Jun C, Shimizu Hiroaki, Ikawa Fusao
Department of Neurosurgery, Shimane Prefectural Hospital, Izumo 693-0068, Japan.
Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan.
J Clin Med. 2025 Jun 10;14(12):4107. doi: 10.3390/jcm14124107.
: Since clazosentan was approved for insurance coverage in Japan, the postoperative management of delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) has changed as each facility gains experience. Here, we investigate the prevention, treatment, and management of DCI after SAH throughout Japan in 2023. : In 2024, we conducted an anonymous questionnaire survey-emailed to certified neurosurgeons in hospitals across Japan-regarding management for preventing DCI after aneurysmal SAH. Of them, 78 hospitals responded and were included in this study. These results were compared with the findings of a survey conducted prior to the approval of clazosentan in Japan (2022). : The proportion of institutions with a standardized protocol for DCI after aneurysmal SAH at a level of ≥50% was 93.0%. For both craniotomy and endovascular surgery, clazosentan was used most frequently, followed by cilostazol, fasudil, and statins. The most common drug for both direct and endovascular procedures was clazosentan. The predominant reason for discontinuing clazosentan was respiratory complications-such as pulmonary edema-followed by cardiac complications. However, 62.1% of facilities felt that the number of cases wherein clazosentan was discontinued was deceasing. While 77.5% of respondents felt that clazosentan was effective for preventing DCI after aneurysmal SAH, only 49.3% felt that it improved outcomes. : Since its approval, clazosentan has been the most common treatment for DCI prevention after aneurysmal SAH. The impression of the effectiveness in preventing DCI and the outcomes of clazosentan have been mixed. As data accumulate, clazosentan use and management protocols will be refined and developed.
自克拉唑森坦在日本被批准纳入医保范围以来，随着各医疗机构积累经验，蛛网膜下腔出血（SAH）后迟发性脑缺血（DCI）的术后管理发生了变化。在此，我们对2023年日本全国范围内SAH后DCI的预防、治疗和管理情况进行调查。在2024年，我们针对动脉瘤性SAH后预防DCI的管理措施，向日本各地医院的神经外科专科医生发送了一份匿名问卷调查邮件。其中，78家医院回复并被纳入本研究。这些结果与克拉唑森坦在日本获批之前（2022年）进行的一项调查结果进行了比较。动脉瘤性SAH后DCI有标准化方案的机构比例达到≥50%的为93.0%。对于开颅手术和血管内手术，克拉唑森坦的使用最为频繁，其次是西洛他唑、法舒地尔和他汀类药物。开颅手术和血管内手术最常用的药物都是克拉唑森坦。停用克拉唑森坦的主要原因是呼吸系统并发症，如肺水肿，其次是心脏并发症。然而，62.1%的医疗机构认为克拉唑森坦停药的病例数在减少。虽然77.5%的受访者认为克拉唑森坦对预防动脉瘤性SAH后的DCI有效，但只有49.3%的人认为它能改善预后。自获批以来，克拉唑森坦一直是动脉瘤性SAH后预防DCI最常用 的治疗方法。克拉唑森坦在预防DCI方面的有效性印象和治疗效果喜忧参半。随着数据的积累，克拉唑森坦的使用和管理方案将得到完善和发展。
