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Japanese Nationwide Questionnaire Survey on the Treatment and Management of Subarachnoid Hemorrhage Due to Ruptured

Toshikazu Hidaka1, Junichiro Ochiai1, Yusuke Inoue1

  • 1Department of Neurosurgery, Shimane Prefectural Hospital, Izumo 693-0068, Japan.

Journal of Clinical Medicine
|June 26, 2025
PubMed

Insights

Clazosentan is now the most common treatment for preventing delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) in Japan. While effective for prevention, its impact on patient outcomes remains mixed, with ongoing refinement of its use and management protocols.

Area of Science:

  • Neurosurgery
  • Neurology
  • Pharmacology

Background:

  • Delayed cerebral ischemia (DCI) remains a critical complication following subarachnoid hemorrhage (SAH).
  • The introduction of clazosentan for insurance coverage in Japan has influenced DCI management strategies.
  • Hospital experiences with clazosentan have evolved since its approval, necessitating updated assessments of DCI care.

Purpose of the Study:

  • To investigate the current prevention, treatment, and management of DCI after aneurysmal SAH in Japan.
  • To compare 2023 DCI management practices with pre-clazosentan approval data from 2022.
  • To assess the perceived effectiveness and outcomes associated with clazosentan use.

Main Methods:

  • An anonymous questionnaire survey was distributed to certified neurosurgeons across Japan in 2024.
  • The survey focused on DCI prevention and management strategies following aneurysmal SAH.
  • Responses from 78 hospitals were analyzed and compared to a 2022 survey baseline.

Main Results:

  • 93.0% of institutions reported standardized DCI protocols; clazosentan was the most frequently used drug for DCI prevention in both craniotomy and endovascular procedures.
  • Respiratory complications (e.g., pulmonary edema) were the primary reason for discontinuing clazosentan, though 62.1% noted a decrease in such discontinuations.
  • While 77.5% of respondents found clazosentan effective for DCI prevention, only 49.3% believed it improved patient outcomes.

Conclusions:

  • Clazosentan has become the predominant treatment for DCI prevention post-SAH in Japan since its approval.
  • Clinician perceptions regarding clazosentan's effectiveness in preventing DCI are generally positive, but its impact on overall patient outcomes is viewed more cautiously.
  • Further data accumulation is expected to refine clazosentan utilization and optimize management protocols for DCI.

Keywords:
cerebral vasospasmclazosentandelayed cerebral ischemiasubarachnoid hemorrhagesurvey

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