{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T19:09:41Z","timestamp":1784920181630,"version":"3.55.0"},"reference-count":41,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:00:00Z","timestamp":1760054400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:00:00Z","timestamp":1760054400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004823","name":"Nagoya University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004823","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Neurosurg Rev"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Controlling delayed cerebral ischemia (DCI) is crucial for improving the prognosis in patients with aneurysmal subarachnoid hemorrhage (aSAH). This study aimed to identify prognostic factors in patients with aSAH in Japan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A multicenter, retrospective, observational cohort study was conducted from April 2021 to March 2024. Patients underwent surgical repair of ruptured aneurysms within 48\u00a0h of onset, followed by postoperative treatment with multiple drugs, including clazosentan and fasudil, to prevent cerebral vasospasm. The primary outcome was the proportion of patients with a good outcome, defined as a modified Rankin Scale score of 0 to 2 at discharge. Multivariate logistic regression and stepwise model selection were applied to identify prognostic factors. SHapley Additive exPlanations (SHAP) analysis was used to visualize the relative importance of predictors and their impact on outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 506 patients (mean age 63.5 years, 66.6% female), 53.0% achieved a favorable outcome. In multivariate analysis, treatment with clazosentan was associated with 1.84 times higher odds of a favorable outcome (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.021), increasing to 1.97 when clazosentan was administered without fluid retention complications (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.010). SHAP analysis further highlighted the impact of each factor on prognosis, identifying a lower WFNS grade, lower Fisher grade, younger age, clazosentan, cilostazol, and statin use as significant predictors of favorable outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Clinical status at aSAH onset and age are uncontrollable factors; therefore, improving prognosis requires targeted prevention of DCI and effective management of brain edema. The administration of therapies such as clazosentan, cilostazol, and statins may contribute to favorable outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial number<\/jats:title>\n                    <jats:p>Not applicable<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10143-025-03858-7","type":"journal-article","created":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T07:30:11Z","timestamp":1760081411000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Prognostic factors in aneurysmal subarachnoid hemorrhage during the clazosentan era: a multicenter study using multivariate analyses and machine learning model"],"prefix":"10.1007","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4225-110X","authenticated-orcid":false,"given":"Shinsuke","family":"Muraoka","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Izumi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuki","family":"Ishii","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Issei","family":"Takeuchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Nishihori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunsaku","family":"Goto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fumiaki","family":"Kanamori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenji","family":"Uda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Sakamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kinya","family":"Yokoyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuki","family":"Nishida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basile","family":"Chretien","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryuta","family":"Saito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,10]]},"reference":[{"key":"3858_CR1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2024.105689","volume":"193","author":"Y Abas Mohamed","year":"2025","unstructured":"Abas Mohamed Y, Ee Khoo B, Shahrimie Mohd Asaari M, Ezane Aziz M, Rahiman Ghazali F (2025) Decoding the black box: explainable AI (XAI) for cancer diagnosis, prognosis, and treatment planning-a state-of-the art systematic review. Int J Med Inform 193:105689. https:\/\/doi.org\/10.1016\/j.ijmedinf.2024.105689","journal-title":"Int J Med Inform"},{"key":"3858_CR2","doi-asserted-by":"publisher","first-page":"52138","DOI":"10.1109\/ACCESS.2018.2870052","volume":"6","author":"A Adadi","year":"2018","unstructured":"Adadi A, Berrada M (2018) Peeking inside the black-box: a survey on explainable artificial intelligence (XAI). IEEE Access 6:52138\u201352160","journal-title":"IEEE Access"},{"key":"3858_CR3","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1016\/j.wneu.2021.02.069","volume":"150","author":"S Bohara","year":"2021","unstructured":"Bohara S, Garg K, Singh Rajpal PM, Kasliwal M (2021) Role of cilostazol in prevention of vasospasm after aneurysmal subarachnoid hemorrhage-a systematic review, meta-analysis, and trial sequential analysis. World Neurosurg 150:161\u2013170. https:\/\/doi.org\/10.1016\/j.wneu.2021.02.069","journal-title":"World Neurosurg"},{"key":"3858_CR4","unstructured":"Cao Y, Chiu HK, Khosla A, Chiung C, Lin Y (2020) Cs229 Project: a machine learning approach to stroke risk prediction. CiteseerX. https:\/\/citeseerx.ist.psu.edu\/viewdoc\/summary?doi=10.1.1.375.1202"},{"key":"3858_CR5","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1097\/WNF.0000000000000489","volume":"45","author":"H Chen","year":"2022","unstructured":"Chen H, Luo W, Cai X, Cai J (2022) Cilostazol administration for subarachnoid hemorrhage: a meta-analysis of randomized controlled trials. Clin Neuropharmacol 45:111\u2013116. https:\/\/doi.org\/10.1097\/WNF.0000000000000489","journal-title":"Clin Neuropharmacol"},{"key":"3858_CR6","doi-asserted-by":"publisher","first-page":"846","DOI":"10.1016\/S0140-6736(22)00938-2","volume":"400","author":"J Claassen","year":"2022","unstructured":"Claassen J, Park S (2022) Spontaneous subarachnoid haemorrhage. Lancet 400:846\u2013862. https:\/\/doi.org\/10.1016\/S0140-6736(22)00938-2","journal-title":"Lancet"},{"key":"3858_CR7","doi-asserted-by":"publisher","first-page":"1993","DOI":"10.1161\/STROKEAHA.121.035699","volume":"53","author":"M Dayyani","year":"2022","unstructured":"Dayyani M, Sadeghirad B, Grotta JC et al (2022) Prophylactic therapies for morbidity and mortality after aneurysmal subarachnoid hemorrhage: a systematic review and network meta-analysis of randomized trials. Stroke 53:1993\u20132005. https:\/\/doi.org\/10.1161\/STROKEAHA.121.035699","journal-title":"Stroke"},{"key":"3858_CR8","doi-asserted-by":"publisher","first-page":"1707","DOI":"10.3171\/2022.2.JNS212914","volume":"137","author":"H Endo","year":"2022","unstructured":"Endo H, Hagihara Y, Kimura N, Takizawa K, Niizuma K, Togo O, Tominaga T (2022) Effects of clazosentan on cerebral vasospasm-related morbidity and all-cause mortality after aneurysmal subarachnoid hemorrhage: two randomized phase 3 trials in Japanese patients. J Neurosurg 137:1707\u20131717. https:\/\/doi.org\/10.3171\/2022.2.JNS212914","journal-title":"J Neurosurg"},{"key":"3858_CR9","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1001\/jamaneurol.2019.0006","volume":"76","author":"N Etminan","year":"2019","unstructured":"Etminan N, Chang HS, Hackenberg K, De Rooij NK, Vergouwen MDI, Rinkel GJE, Algra A (2019) Worldwide incidence of aneurysmal subarachnoid hemorrhage according to region, time period, blood pressure, and smoking prevalence in the population: a systematic review and meta-analysis. JAMA Neurol 76:588\u2013597. https:\/\/doi.org\/10.1001\/jamaneurol.2019.0006","journal-title":"JAMA Neurol"},{"key":"3858_CR10","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1093\/biomet\/80.1.27","volume":"80","author":"D Firth","year":"1993","unstructured":"Firth D (1993) Bias reduction of maximum likelihood estimates. Biometrika 80:27\u201338","journal-title":"Biometrika"},{"key":"3858_CR11","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1227\/00006123-197711000-00004","volume":"1","author":"CM Fisher","year":"1977","unstructured":"Fisher CM, Roberson GH, Ojemann RG (1977) Cerebral vasospasm with ruptured saccular aneurysm\u2014the clinical manifestations. Neurosurgery 1:245\u2013248. https:\/\/doi.org\/10.1227\/00006123-197711000-00004","journal-title":"Neurosurgery"},{"key":"3858_CR12","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1159\/000475824","volume":"44","author":"M Fujimura","year":"2017","unstructured":"Fujimura M, Joo JY, Kim JS, Hatta M, Yokoyama Y, Tominaga T (2017) Preventive effect of Clazosentan against cerebral vasospasm after clipping surgery for aneurysmal subarachnoid hemorrhage in Japanese and Korean patients. Cerebrovasc Dis 44:59\u201367. https:\/\/doi.org\/10.1159\/000475824","journal-title":"Cerebrovasc Dis"},{"key":"3858_CR13","doi-asserted-by":"publisher","first-page":"982498","DOI":"10.3389\/fneur.2022.982498","volume":"13","author":"G Hao","year":"2022","unstructured":"Hao G, Chu G, Pan P, Han Y, Ai Y, Shi Z, Liang G (2022) Clinical effectiveness of nimodipine for the prevention of poor outcome after aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. Front Neurol 13:982498","journal-title":"Front Neurol"},{"key":"3858_CR14","doi-asserted-by":"publisher","first-page":"e314","DOI":"10.1161\/STR.0000000000000436","volume":"54","author":"BL Hoh","year":"2023","unstructured":"Hoh BL, Ko NU, Amin-Hanjani S et al (2023) 2023 guideline for the management of patients with aneurysmal subarachnoid hemorrhage: a guideline from the American Heart Association\/American Stroke Association. Stroke 54:e314\u2013e370. https:\/\/doi.org\/10.1161\/STR.0000000000000436","journal-title":"Stroke"},{"key":"3858_CR15","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1254\/jphs.13r02cr","volume":"123","author":"T Horinouchi","year":"2013","unstructured":"Horinouchi T, Terada K, Higashi T, Miwa S (2013) Endothelin receptor signaling: new insight into its regulatory mechanisms. J Pharmacol Sci 123:85\u2013101. https:\/\/doi.org\/10.1254\/jphs.13r02cr","journal-title":"J Pharmacol Sci"},{"key":"3858_CR16","doi-asserted-by":"publisher","first-page":"1587","DOI":"10.1038\/jcbfm.2015.81","volume":"35","author":"R Jabbarli","year":"2015","unstructured":"Jabbarli R, Reinhard M, Roelz R et al (2015) Early identification of individuals at high risk for cerebral infarction after aneurysmal subarachnoid hemorrhage: the BEHAVIOR score. J Cereb Blood Flow Metab 35:1587\u20131592. https:\/\/doi.org\/10.1038\/jcbfm.2015.81","journal-title":"J Cereb Blood Flow Metab"},{"key":"3858_CR17","doi-asserted-by":"publisher","first-page":"644","DOI":"10.3171\/2014.10.JNS132694","volume":"122","author":"BNR Jaja","year":"2015","unstructured":"Jaja BNR, Lingsma H, Schweizer TA, Thorpe KE, Steyerberg EW, Macdonald RL (2015) Prognostic value of premorbid hypertension and neurological status in aneurysmal subarachnoid hemorrhage: pooled analyses of individual patient data in the SAHIT repository. J Neurosurg 122:644\u2013652. https:\/\/doi.org\/10.3171\/2014.10.JNS132694","journal-title":"J Neurosurg"},{"issue":"4","key":"3858_CR18","doi-asserted-by":"publisher","first-page":"392","DOI":"10.3340\/jkns.2024.0195","volume":"68","author":"SH Lee","year":"2025","unstructured":"Lee SH, Choi KS, Togo O, Park IS (2025) Comparison of Clazosentan and nimodipine on vasospasm and vasospasm-related outcomes after aneurysmal subarachnoid hemorrhage: a post-hoc propensity score-matched analysis of six randomized clinical trials. J Korean Neurosurg Soc 68(4):392\u2013404","journal-title":"J Korean Neurosurg Soc"},{"key":"3858_CR19","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1159\/000518731","volume":"51","author":"J Liu","year":"2022","unstructured":"Liu J, He J, Chen X et al (2022) Cilostazol for aneurysmal subarachnoid hemorrhage: an updated systematic review and meta-analysis. Cerebrovasc Dis 51:138\u2013148. https:\/\/doi.org\/10.1159\/000518731","journal-title":"Cerebrovasc Dis"},{"key":"3858_CR20","first-page":"4765","volume":"20","author":"SM Lundberg","year":"2017","unstructured":"Lundberg SM, Lee SI (2017) A unified approach to interpreting model predictions. Adv Neural Inf Process Syst 20:4765\u20134774","journal-title":"Adv Neural Inf Process Syst"},{"issue":"11","key":"3858_CR21","doi-asserted-by":"publisher","first-page":"3015","DOI":"10.1161\/STROKEAHA.108.519942","volume":"39","author":"RL Macdonald","year":"2008","unstructured":"Macdonald RL, Kassell NF, Mayer S et al (2008) Clazosentan to overcome neurological ischemia and infarction occurring after subarachnoid hemorrhage (CONSCIOUS-1): randomized, double-blind, placebo-controlled phase 2 dose-finding trial. Stroke 39(11):3015\u20133021","journal-title":"Stroke"},{"issue":"7","key":"3858_CR22","doi-asserted-by":"publisher","first-page":"618","DOI":"10.1016\/S1474-4422(11)70108-9","volume":"10","author":"RL Macdonald","year":"2011","unstructured":"Macdonald RL, Higashida RT, Keller E et al (2011) Clazosentan, an endothelin receptor antagonist, in patients with aneurysmal subarachnoid haemorrhage undergoing surgical clipping: a randomized, double-blind, placebo-controlled phase 3 trial (CONSCIOUS-2). Lancet Neurol 10(7):618\u2013625","journal-title":"Lancet Neurol"},{"issue":"6","key":"3858_CR23","doi-asserted-by":"publisher","first-page":"1463","DOI":"10.1161\/STROKEAHA.111.648980","volume":"43","author":"RL Macdonald","year":"2012","unstructured":"Macdonald RL, Higashida RT, Keller E et al (2012) Randomized trial of Clazosentan in patients with aneurysmal subarachnoid hemorrhage undergoing endovascular coiling. Stroke 43(6):1463\u20131469","journal-title":"Stroke"},{"key":"3858_CR24","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1038\/nrneurol.2013.246","volume":"10","author":"RL Macdonald","year":"2014","unstructured":"Macdonald RL (2014) Delayed neurological deterioration after subarachnoid haemorrhage. Nat Rev Neurol 10:44\u201358. https:\/\/doi.org\/10.1038\/nrneurol.2013.246","journal-title":"Nat Rev Neurol"},{"key":"3858_CR25","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1016\/S0140-6736(16)30668-7","volume":"389","author":"RL Macdonald","year":"2017","unstructured":"Macdonald RL, Schweizer TA (2017) Spontaneous subarachnoid haemorrhage. Lancet 389:655\u2013666. https:\/\/doi.org\/10.1016\/S0140-6736(16)30668-7","journal-title":"Lancet"},{"key":"3858_CR26","first-page":"1","volume":"9","author":"SA Mayer","year":"2024","unstructured":"Mayer SA, Bruder N, Citerio G et al (2024) REACT: a randomized trial to assess the efficacy and safety of Clazosentan for preventing clinical deterioration due to delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. J Neurosurg 9:1\u201312","journal-title":"J Neurosurg"},{"key":"3858_CR27","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2019.105558","volume":"187","author":"MK McIntyre","year":"2019","unstructured":"McIntyre MK, Gandhi C, Long A et al (2019) Age predicts outcomes better than frailty following aneurysmal subarachnoid hemorrhage: a retrospective cohort analysis. Clin Neurol Neurosurg 187:105558. https:\/\/doi.org\/10.1016\/j.clineuro.2019.105558","journal-title":"Clin Neurol Neurosurg"},{"key":"3858_CR28","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1007\/s10143-024-02345-9","volume":"47","author":"T Mochizuki","year":"2024","unstructured":"Mochizuki T, Ryu B, Shima S et al (2024) Comparison of efficacy between Clazosentan and fasudil hydrochloride-based management of vasospasm after subarachnoid hemorrhage focusing on older and WFNS grade V patients: a single-center experience in Japan. Neurosurg Rev 47:113. https:\/\/doi.org\/10.1007\/s10143-024-02345-9","journal-title":"Neurosurg Rev"},{"key":"3858_CR29","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1007\/s10143-023-02104-2","volume":"46","author":"S Muraoka","year":"2023","unstructured":"Muraoka S, Asai T, Fukui T et al (2023) Real-world data of Clazosentan in combination therapy for aneurysmal subarachnoid hemorrhage: a multicenter retrospective cohort study. Neurosurg Rev 46:195. https:\/\/doi.org\/10.1007\/s10143-023-02104-2","journal-title":"Neurosurg Rev"},{"key":"3858_CR30","doi-asserted-by":"publisher","unstructured":"Muraoka S, Izumi T, Nishida K et al (2025) RECOVER (REtrospective study of Clazosentan and fasudil in subarachnoid hemorrhage: vasospasm prEvention and patient pRognosis) Study \u2013 comparison of efficacy and safety of clazosentan and fasudil in patients with aneurysmal subarachnoid hemorrhage: a multicenter retrospective cohort study. J Neurosurg. Published online May 16, 2025. https:\/\/doi.org\/10.3171\/2025.1.JNS242509","DOI":"10.3171\/2025.1.JNS242509"},{"key":"3858_CR31","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpcardiol.2022.101480","volume":"48","author":"H Ren","year":"2023","unstructured":"Ren H, Sun Y, Xu C (2023) Predicting acute onset of heart failure complicating acute coronary syndrome: an explainable machine learning approach. Curr Probl Cardiol 48:101480. https:\/\/doi.org\/10.1016\/j.cpcardiol.2022.101480","journal-title":"Curr Probl Cardiol"},{"key":"3858_CR32","doi-asserted-by":"publisher","first-page":"1110","DOI":"10.1016\/S0022-3565(24)37130-7","volume":"283","author":"S Roux","year":"1997","unstructured":"Roux S, Breu V, Giller T et al (1997) Ro 61-1790, a new hydrosoluble endothelin antagonist: general pharmacology and effects on experimental cerebral vasospasm. J Pharmacol Exp Ther 283:1110\u20131118","journal-title":"J Pharmacol Exp Ther"},{"key":"3858_CR33","doi-asserted-by":"publisher","first-page":"1413632","DOI":"10.3389\/fneur.2024.1413632","volume":"15","author":"H Sakata","year":"2024","unstructured":"Sakata H, Kanoke A, Uchida H et al (2024) Prophylactic management of cerebral vasospasm with clazosentan in real clinical practice: a single-center retrospective cohort study. Front Neurol 15:1413632. https:\/\/doi.org\/10.3389\/fneur.2024.1413632","journal-title":"Front Neurol"},{"key":"3858_CR34","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1161\/01.res.87.3.195","volume":"87","author":"M Sato","year":"2000","unstructured":"Sato M, Tani E, Fujikawa H, Kaibuchi K (2000) Involvement of Rho-kinase-mediated phosphorylation of myosin light chain in enhancement of cerebral vasospasm. Circ Res 87:195\u2013200. https:\/\/doi.org\/10.1161\/01.res.87.3.195","journal-title":"Circ Res"},{"key":"3858_CR35","doi-asserted-by":"publisher","DOI":"10.3171\/foc.2002.12.3.8","volume":"12","author":"E Tani","year":"2002","unstructured":"Tani E (2002) Molecular mechanisms involved in development of cerebral vasospasm. Neurosurg Focus 12:ECP1. https:\/\/doi.org\/10.3171\/foc.2002.12.3.8","journal-title":"Neurosurg Focus"},{"key":"3858_CR36","doi-asserted-by":"publisher","first-page":"1850","DOI":"10.1038\/s41467-024-46015-2","volume":"15","author":"S Thilak","year":"2024","unstructured":"Thilak S, Brown P, Whitehouse T, Gautam N, Lawrence E, Ahmed Z, Veenith T (2024) Diagnosis and management of subarachnoid haemorrhage. Nat Commun 15:1850. https:\/\/doi.org\/10.1038\/s41467-024-46015-2","journal-title":"Nat Commun"},{"key":"3858_CR37","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1093\/brain\/124.2.249","volume":"124","author":"J van Gijn","year":"2001","unstructured":"van Gijn J, Rinkel GJE (2001) Subarachnoid haemorrhage: diagnosis, causes and management. Brain 124:249\u2013278. https:\/\/doi.org\/10.1093\/brain\/124.2.249","journal-title":"Brain"},{"key":"3858_CR38","doi-asserted-by":"publisher","first-page":"1545","DOI":"10.1038\/jcbfm.2011.56","volume":"31","author":"MDI Vergouwen","year":"2011","unstructured":"Vergouwen MDI, Etminan N, Ilodigwe D, Macdonald RL (2011) Lower incidence of cerebral infarction correlates with improved functional outcome after aneurysmal subarachnoid hemorrhage. J Cereb Blood Flow Metab 31:1545\u20131553. https:\/\/doi.org\/10.1038\/jcbfm.2011.56","journal-title":"J Cereb Blood Flow Metab"},{"key":"3858_CR39","doi-asserted-by":"publisher","first-page":"924","DOI":"10.1161\/STROKEAHA.110.597914","volume":"42","author":"MDI Vergouwen","year":"2011","unstructured":"Vergouwen MDI, Ilodigwe D, Macdonald RL (2011) Cerebral infarction after subarachnoid hemorrhage contributes to poor outcome by vasospasm-dependent and -independent effects. Stroke 42:924\u2013929. https:\/\/doi.org\/10.1161\/STROKEAHA.110.597914","journal-title":"Stroke"},{"issue":"10","key":"3858_CR40","doi-asserted-by":"publisher","first-page":"679","DOI":"10.2176\/nmc.51.679","volume":"51","author":"J Zhao","year":"2011","unstructured":"Zhao J, Zhou D, Guo J et al (2011) Efficacy and safety of fasudil in patients with subarachnoid hemorrhage: final results of a randomized trial of fasudil versus nimodipine. Neurol Med Chir (Tokyo) 51(10):679\u2013683","journal-title":"Neurol Med Chir (Tokyo)"},{"key":"3858_CR41","doi-asserted-by":"publisher","first-page":"131","DOI":"10.3389\/fneur.2020.00131","volume":"11","author":"J Zheng","year":"2020","unstructured":"Zheng J, Sun X, Zhang X (2020) Influence of age-related complications on clinical outcome in patients with small ruptured cerebral aneurysms. Front Neurol 11:131. https:\/\/doi.org\/10.3389\/fneur.2020.00131","journal-title":"Front Neurol"}],"container-title":["Neurosurgical Review"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10143-025-03858-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10143-025-03858-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10143-025-03858-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T04:16:24Z","timestamp":1772079384000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10143-025-03858-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,10]]},"references-count":41,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["3858"],"URL":"https:\/\/doi.org\/10.1007\/s10143-025-03858-7","relation":{},"ISSN":["1437-2320"],"issn-type":[{"value":"1437-2320","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,10]]},"assertion":[{"value":"15 April 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 August 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 September 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 October 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was conducted in accordance with the 1964 Declaration of Helsinki and its later amendments and approved by the Institutional Review Board (IRB) of Nagoya University Hospital (approval number: 2022\u2009\u2212\u20090476). Informed consent was waived as the analysis used anonymized clinical data collected after obtaining written informed consent for treatment. Additionally, patient approval was obtained via an IRB-approved opt-out poster displayed in the outpatient department and neurosurgery ward.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All authors have read and agreed to the published version of the manuscript, and consent to its publication.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The last author, Professor Ryuta Saito, received research funding from Nxera Pharma Japan, the distributor of clazosentan. However, Professor Saito was not involved in the planning or analysis of this study and contributed solely in supervisory capacity. The other authors did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"690"}}