クラゾセンタン投与終了後のdelayed cerebral ischemia

吉本 舞; 春原 匡; 福井 伸行; 大賀 勇範; 髙松 昂央; 徳田 匡紀; 冨田 ひかり; 﨑須賀 涼; 野本 未佳子; 笠島 一洋; 山元 康弘; 宮田 真友子; 石川 友美; 髙原 正樹; 福光 龍; 後藤 正憲; 小柳 正臣; 太田 剛史

doi:10.2335/scs.53.327

Case Reports

Delayed Cerebral Ischemia Following the Completion of Clazosentan Administration

Mai YOSHIMOTO, Tadashi SUNOHARA, Nobuyuki FUKUI, Takenori OHGA, Takateru TAKAMATSU, Masanori TOKUDA, Hikari TOMITA, Ryo SAKISUKA, Mikako NOMOTO, Kazuhiro KASASHIMA, Yasuhiro YAMAMOTO, Mayuko MIYATA, Tomomi ISHIKAWA, Masaki TAKAHARA, Ryu FUKUMITSU, Masanori GOTO, Masaomi KOYANAGI, Tsuyoshi OHTA

Author information

Mai YOSHIMOTO
Department of Neurosurgery, Kobe City Medical Center General Hospital
Tadashi SUNOHARA
Department of Neurosurgery, Kobe City Medical Center General Hospital
Nobuyuki FUKUI
Department of Neurosurgery, Kobe City Medical Center General Hospital
Takenori OHGA
Department of Neurosurgery, Kobe City Medical Center General Hospital
Takateru TAKAMATSU
Department of Neurosurgery, Kobe City Medical Center General Hospital
Masanori TOKUDA
Department of Neurosurgery, Kobe City Medical Center General Hospital
Hikari TOMITA
Department of Neurosurgery, Kobe City Medical Center General Hospital
Ryo SAKISUKA
Department of Neurosurgery, Kobe City Medical Center General Hospital
Mikako NOMOTO
Department of Neurosurgery, Kobe City Medical Center General Hospital
Kazuhiro KASASHIMA
Department of Neurosurgery, Kobe City Medical Center General Hospital
Yasuhiro YAMAMOTO
Department of Neurosurgery, Kobe City Medical Center General Hospital
Mayuko MIYATA
Department of Neurosurgery, Kobe City Medical Center General Hospital
Tomomi ISHIKAWA
Department of Neurosurgery, Kobe City Medical Center General Hospital
Masaki TAKAHARA
Department of Neurosurgery, Kobe City Medical Center General Hospital
Ryu FUKUMITSU
Department of Neurosurgery, Kobe City Medical Center General Hospital
Masanori GOTO
Department of Neurosurgery, Kobe City Medical Center General Hospital
Masaomi KOYANAGI
Department of Neurosurgery, Kobe City Medical Center General Hospital
Tsuyoshi OHTA
Department of Neurosurgery, Kobe City Medical Center General Hospital

Keywords: subarachnoid hemorrhage, clazosentan, vasospasm, delayed cerebral ischemia, aneurysm

JOURNAL FREE ACCESS

2025 Volume 53 Issue 5 Pages 327-332

DOI https://doi.org/10.2335/scs.53.327

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Abstract

Herein, we report two cases of delayed cerebral ischemia (DCI) associated with angiographic vasospasm (AVS) that occurred after the completion of clazosentan treatment: one newly developed and one progressive.

Case 1: A female in her 80s (World Federation of Neurosurgical Societies [WFNS] grade 2) underwent coil embolization for a right middle cerebral artery (MCA) bifurcation aneurysm. No AVS or DCI was observed during clazosentan administration (days 3–14). However, on days 17, 19, and 20, AVS/DCI developed in the right MCA, requiring intra-arterial fasudil hydrochloride injections. Dehydration was suspected to be a contributing factor.

Case 2: A female in her 50s (WFNS grade 5) underwent coil embolization for aneurysms in the anterior communicating artery (Acom) and the paraclinoid internal carotid artery. During clazosentan administration, AVS or DCI was observed in the MCA and Acom on day 10. AVS or DCI recurred on day 17 and was treated with intravenous fasudil hydrochloride and increased fluid supplementation.

These cases suggest that careful observation for DCI is required after the completion of clazosentan treatment.

Corresponding author

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