OBJECT: Clazosentan therapy after aneurysmal subarachnoid hemorrhage (SAH) has been found to be effective in reducing the incidence of vasospasm in randomized controlled trials. However, while vasospasm-related morbidity, including delayed ischemic neurological deficits (DINDs) and delayed cerebral infarctions, was consistently decreased, statistical significance was not demonstrated and outcomes were not affected by clazosentan treatment. The objective of this meta-analysis was to determine whether clazosentan treatment after aneurysmal SAH significantly reduced the incidence of DINDs and delayed cerebral infarctions and improved outcomes. METHODS: All randomized controlled trials investigating the effect of clazosentan were retrieved via searches with sensitive and specific terms. Six variables were abstracted after the assessment of the methodological quality of the trials. Analyses were performed following the method guidelines of the Cochrane Back Review Group. RESULTS: Four randomized, placebo-controlled trials met eligibility criteria, enrolling a total of 2181 patients. The meta-analysis demonstrated a significant decrease in the incidence of DINDs (relative risk [RR] 0.76 [95% CI 0.62-0.92]) and delayed cerebral infarction (RR 0.79 [95% CI 0.63-1.00]) in patients treated with clazosentan after aneurysmal SAH. However, this treatment regimen was not shown to outcomes including functional outcomes measured by Glasgow Outcome Scale-Extended (RR 1.12 [95% CI 0.96-1.30]) or mortality (RR 1.02 [95%CI 0.70-1.49]). Adverse events, including pulmonary complications, anemia, and hypotension, were all significantly increased in patients who received clazosentan therapy. CONCLUSIONS: The results of the present meta-analysis show that treatment with clazosentan after aneurysmal SAH significantly reduced the incidence of the vasospasm-related DINDs and delayed cerebral infarctions, but did not improve poor neurological outcomes in patients with aneurysmal SAH. Further study is required to elucidate the dissociation between vasospasm-related morbidity and outcomes.
OBJECT: Clazosentan therapy after aneurysmal subarachnoid hemorrhage (SAH) has been found to be effective in reducing the incidence of vasospasm in randomized controlled trials. However, while vasospasm-related morbidity, including delayed ischemic neurological deficits (DINDs) and delayed cerebral infarctions, was consistently decreased, statistical significance was not demonstrated and outcomes were not affected by clazosentan treatment. The objective of this meta-analysis was to determine whether clazosentan treatment after aneurysmalSAH significantly reduced the incidence of DINDs and delayed cerebral infarctions and improved outcomes. METHODS: All randomized controlled trials investigating the effect of clazosentan were retrieved via searches with sensitive and specific terms. Six variables were abstracted after the assessment of the methodological quality of the trials. Analyses were performed following the method guidelines of the Cochrane Back Review Group. RESULTS: Four randomized, placebo-controlled trials met eligibility criteria, enrolling a total of 2181 patients. The meta-analysis demonstrated a significant decrease in the incidence of DINDs (relative risk [RR] 0.76 [95% CI 0.62-0.92]) and delayed cerebral infarction (RR 0.79 [95% CI 0.63-1.00]) in patients treated with clazosentan after aneurysmalSAH. However, this treatment regimen was not shown to outcomes including functional outcomes measured by Glasgow Outcome Scale-Extended (RR 1.12 [95% CI 0.96-1.30]) or mortality (RR 1.02 [95%CI 0.70-1.49]). Adverse events, including pulmonary complications, anemia, and hypotension, were all significantly increased in patients who received clazosentan therapy. CONCLUSIONS: The results of the present meta-analysis show that treatment with clazosentan after aneurysmalSAH significantly reduced the incidence of the vasospasm-related DINDs and delayed cerebral infarctions, but did not improve poor neurological outcomes in patients with aneurysmalSAH. Further study is required to elucidate the dissociation between vasospasm-related morbidity and outcomes.
Authors: Neil A Nadkarni; Matthew B Maas; Ayush Batra; Minjee Kim; Edward M Manno; Farzaneh A Sorond; Shyam Prabhakaran; Andrew M Naidech; Eric M Liotta Journal: J Stroke Cerebrovasc Dis Date: 2020-01-11 Impact factor: 2.136
Authors: M-A Labeyrie; S Gaugain; G Boulouis; A Zetchi; J Brami; J-P Saint-Maurice; V Civelli; S Froelich; E Houdart Journal: AJNR Am J Neuroradiol Date: 2019-07-18 Impact factor: 3.825
Authors: Michael Hugelshofer; Raphael M Buzzi; Christian A Schaer; Henning Richter; Kevin Akeret; Vania Anagnostakou; Leila Mahmoudi; Raphael Vaccani; Florence Vallelian; Jeremy W Deuel; Peter W Kronen; Zsolt Kulcsar; Luca Regli; Jin Hyen Baek; Ivan S Pires; Andre F Palmer; Matthias Dennler; Rok Humar; Paul W Buehler; Patrick R Kircher; Emanuela Keller; Dominik J Schaer Journal: J Clin Invest Date: 2019-12-02 Impact factor: 14.808
Authors: Adnan I Qureshi; Nauman Jahangir; Mushtaq H Qureshi; Archie Defillo; Ahmed A Malik; Gregory T Sherr; M Fareed K Suri Journal: Neurocrit Care Date: 2015-06 Impact factor: 3.210
Authors: Adnan I Qureshi; Ammad Ishfaq; Muhammad F Ishfaq; Abhi Pandhi; Sundas I Ahmed; Savdeep Singh; Ali Kerro; Rashi Krishnan; Aman Deep; Alexandros L Georgiadis Journal: J Vasc Interv Neurol Date: 2018-11