{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T10:31:27Z","timestamp":1785148287512,"version":"3.55.0"},"reference-count":26,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n Vasospasms associated with dural arteriovenous fistula (dAVF)-related subarachnoid hemorrhage (SAH) are rare, and their management has not been well established. Clazosentan, a selective endothelin A receptor antagonist, is typically administered soon after an SAH to prevent cerebral vasospasms. However, the optimal timing remains controversial because of the risk of fluid retention and related complications. Here, we report the case of dAVF-related SAH in which clazosentan was introduced as rescue therapy to treat cerebral vasospasm.<\/jats:p>\n <\/jats:sec>\n \n Case Description:<\/jats:title>\n A 61-year-old man presented with SAH caused by the rupture of a Borden type III dAVF in the anterior cranial fossa. Following surgical occlusion, intravenous fasudil hydrochloride was administered for vasospasm prophylaxis. However, severe bilateral anterior and middle cerebral artery vasospasms developed on day 10, accompanied by progressive somnolence. Intra-arterial fasudil hydrochloride administration provided limited and transient improvements. Clazosentan was subsequently introduced as rescue therapy and was continuously administered for 4 days. Angiography revealed marked vasodilatation, particularly in the distal vessels, following clazosentan administration. Although fluid retention was observed, the patient was administered diuretics without clinical respiratory deterioration. No cerebral infarction occurred, and the patient was transferred with a favorable outcome (modified Rankin Scale score of 1).<\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n This case suggests that rescue administration of clazosentan may have contributed to improvement as part of multimodal vasospasm management following dAVF-related SAH, with vasodilatory effects comparable to those observed in aneurysmal SAH cases. Furthermore, short-term rescue administration of clazosentan may be tolerable in patients at high risk of fluid retention-related complications when careful fluid management and appropriate diuretic use are implemented.<\/jats:p>\n <\/jats:sec>","DOI":"10.25259\/sni_471_2026","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T09:19:08Z","timestamp":1782465548000},"page":"367","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Rescue clazosentan for symptomatic cerebral vasospasm following subarachnoid hemorrhage due to anterior cranial fossa dural arteriovenous fistula: A case report with serial angiographic evaluation"],"prefix":"10.25259","volume":"17","author":[{"given":"Takahiro","family":"Morita","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Nomura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takao","family":"Sasaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomohiro","family":"Kaji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kohsuke","family":"Katayama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsushi","family":"Saito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"key":"10.25259\/SNI_471_2026\/ref-1","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.hest.2023.10.003","article-title":"Fluid balance management with loop diuretics in patients with aneurysmal subarachnoid hemorrhage treated with clazosentan: A case series","volume":"5","author":"Akamatsu","year":"2024","journal-title":"Brain Hemorrhages"},{"key":"10.25259\/SNI_471_2026\/ref-2","doi-asserted-by":"crossref","first-page":"108296","DOI":"10.1016\/j.jstrokecerebrovasdis.2025.108296","article-title":"Risk factors for clazosentan-induced fluid retention in subarachnoid hemorrhage from the Japanese adverse event database","volume":"34","author":"Ando-Matsuoka","year":"2025","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"10.25259\/SNI_471_2026\/ref-3","doi-asserted-by":"crossref","first-page":"166","DOI":"10.3171\/jns.1995.82.2.0166","article-title":"A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment","volume":"82","author":"Borden","year":"1995","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_471_2026\/ref-4","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1111\/j.1552-6569.2011.00684.x","article-title":"Anterior spinal artery syndrome in a patient with vasospasm secondary to a ruptured cervical Dural arteriovenous fistula","volume":"24","author":"Drazin","year":"2014","journal-title":"J Neuroimaging"},{"key":"10.25259\/SNI_471_2026\/ref-5","doi-asserted-by":"crossref","first-page":"1707","DOI":"10.3171\/2022.2.JNS212914","article-title":"Effects of clazosentan on cerebral vasospasm-related morbidity and all-cause mortality after aneurysmal subarachnoid hemorrhage: Two randomized phase 3 trials in Japanese patients","volume":"137","author":"Endo","year":"2022","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_471_2026\/ref-6","doi-asserted-by":"crossref","first-page":"29","DOI":"10.4103\/sni.sni_396_18","article-title":"Prolonged delayed vasospasm in the setting of nonaneurysmal intraventricular hemorrhage","volume":"10","author":"Fluss","year":"2019","journal-title":"Surg Neurol Int"},{"key":"10.25259\/SNI_471_2026\/ref-7","doi-asserted-by":"crossref","first-page":"e639","DOI":"10.1016\/j.wneu.2019.04.222","article-title":"Reversal of vasospasm with clazosentan after aneurysmal subarachnoid hemorrhage: A pilot study","volume":"128","author":"Higashida","year":"2019","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_471_2026\/ref-8","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.hest.2023.12.001","article-title":"Impact of strict fluid management on the treatment outcome of clazosentan for cerebral vasospasm","volume":"5","author":"Itazu","year":"2024","journal-title":"Brain Hemorrhages"},{"key":"10.25259\/SNI_471_2026\/ref-9","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.hest.2024.01.004","article-title":"Initial results of clazosentan with multiple-drug management for the prevention of cerebral vasospasm after aneurysmal subarachnoid hemorrhage","volume":"5","author":"Kimura","year":"2024","journal-title":"Brain Hemorrhages"},{"key":"10.25259\/SNI_471_2026\/ref-10","doi-asserted-by":"crossref","first-page":"2738","DOI":"10.1161\/STROKEAHA.119.025682","article-title":"Thick and diffuse subarachnoid blood as a treatment effect modifier of clazosentan after subarachnoid hemorrhage","volume":"50","author":"Mayer","year":"2019","journal-title":"Stroke"},{"key":"10.25259\/SNI_471_2026\/ref-11","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1161\/01.STR.32.5.1185","article-title":"Temporal relationship between endothelin-1 concentrations and cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage","volume":"32","author":"Mascia","year":"2001","journal-title":"Stroke"},{"key":"10.25259\/SNI_471_2026\/ref-12","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/j.hest.2025.02.003","article-title":"Perioperative sodium overload is associated with the occurrence of pulmonary complications related to clazosentan in patients with subarachnoid hemorrhage followed by obliterative management for ruptured aneurysm: A retrospective observational study","volume":"6","author":"Mitani","year":"2025","journal-title":"Brain Hemorrhages"},{"key":"10.25259\/SNI_471_2026\/ref-13","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1007\/s10143-024-02345-9","article-title":"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","volume":"47","author":"Mochizuki","year":"2024","journal-title":"Neurosurg Rev"},{"key":"10.25259\/SNI_471_2026\/ref-14","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1007\/s10143-023-02104-2","article-title":"Real-world data of clazosentan in combination therapy for aneurysmal subarachnoid hemorrhage: A multicenter retrospective cohort study","volume":"46","author":"Muraoka","year":"2023","journal-title":"Neurosurg Rev"},{"key":"10.25259\/SNI_471_2026\/ref-15","doi-asserted-by":"crossref","first-page":"e943303","DOI":"10.12659\/MSM.943303","article-title":"Factors influencing discontinuation of clazosentan therapy in elderly patients with aneurysmal subarachnoid hemorrhage: A retrospective study from a Japanese single center","volume":"30","author":"Mutoh","year":"2024","journal-title":"Med Sci Monit"},{"key":"10.25259\/SNI_471_2026\/ref-16","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.hest.2023.11.007","article-title":"A high cardiothoracic ratio increases the risk of severe pulmonary complications after early initiation of clazosentan in patients with aneurysmal subarachnoid hemorrhage","volume":"5","author":"Nishii","year":"2024","journal-title":"Brain Hemorrhages"},{"key":"10.25259\/SNI_471_2026\/ref-17","doi-asserted-by":"crossref","DOI":"10.1177\/15910199251362730","article-title":"Quantitative evaluation of the vasodilatory effect of clazosentan in preventing cerebral vasospasm after subarachnoid hemorrhage","author":"Ogawa","year":"2025","journal-title":"Interv Neuroradiol"},{"key":"10.25259\/SNI_471_2026\/ref-18","first-page":"e79497","article-title":"Treatment outcomes of clazosentan use during the perioperative period for subarachnoid hemorrhage","volume":"17","author":"Okumura","year":"2025","journal-title":"Cureus"},{"key":"10.25259\/SNI_471_2026\/ref-19","first-page":"133","article-title":"[Intra-arterial administration of fasudil hydrochloride: Duration of action]","volume":"33","author":"Ono","year":"2005","journal-title":"No Shinkei Geka"},{"key":"10.25259\/SNI_471_2026\/ref-20","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.jclinepi.2017.04.026","article-title":"CARE guidelines for case reports: Explanation and elaboration document","volume":"89","author":"Riley","year":"2017","journal-title":"J Clin Epidemiol"},{"key":"10.25259\/SNI_471_2026\/ref-21","doi-asserted-by":"crossref","first-page":"1413632","DOI":"10.3389\/fneur.2024.1413632","article-title":"Prophylactic management of cerebral vasospasm with clazosentan in real clinical practice: A single-center retrospective cohort study","volume":"15","author":"Sakata","year":"2024","journal-title":"Front Neurol"},{"key":"10.25259\/SNI_471_2026\/ref-22","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1177\/0271678X251399068","article-title":"Stratified assessment of clazosentan efficacy following subarachnoid hemorrhage: A multi-center cohort study","volume":"46","author":"Sakata","year":"2026","journal-title":"J Cereb Blood Flow Metab"},{"key":"10.25259\/SNI_471_2026\/ref-23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/01616412.2025.2571954","article-title":"Risk factors for fluid retention associated with clazosentan after subarachnoid hemorrhage: A retrospective study","author":"Sekimoto","year":"2025","journal-title":"Neurol Res"},{"key":"10.25259\/SNI_471_2026\/ref-24","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1007\/s10143-025-03646-3","article-title":"Clinical factors associated with delayed ischemic and non-ischemic adverse events in clazosentan therapy after aneurysmal subarachnoid hemorrhage: Early insights from a multicenter prospective registry","volume":"48","author":"Sugiyama","year":"2025","journal-title":"Neurosurg Rev"},{"key":"10.25259\/SNI_471_2026\/ref-25","doi-asserted-by":"crossref","first-page":"9","DOI":"10.3171\/jns.2005.103.1.0009","article-title":"Clazosentan (AXV-034343), a selective endothelin A receptor antagonist, in the prevention of cerebral vasospasm following severe aneurysmal subarachnoid hemorrhage: Results of a randomized, double-blind, placebo-controlled, multicenter phase IIa study","volume":"103","author":"Vajkoczy","year":"2005","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_471_2026\/ref-26","doi-asserted-by":"crossref","first-page":"90","DOI":"10.2176\/jns-nmc.2025-0185","article-title":"Clazosentan affects temporal profile of endothelin-a expression in macro-and microcirculation after subarachnoid hemorrhage","volume":"66","author":"Zheng","year":"2026","journal-title":"Neurol Med Chir (Tokyo)"}],"container-title":["Surgical Neurology International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/surgicalneurologyint.com\/rescue-clazosentan-for-symptomatic-cerebral-vasospasm-following-subarachnoid-hemorrhage-due-to-anterior-cranial-fossa-dural-arteriovenous-fistula-a-case-report-with-serial-angiographic-evaluation\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/rescue-clazosentan-for-symptomatic-cerebral-vasospasm-following-subarachnoid-hemorrhage-due-to-anterior-cranial-fossa-dural-arteriovenous-fistula-a-case-report-with-serial-angiographic-evaluation\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T09:19:11Z","timestamp":1782465551000},"score":1,"resource":{"primary":{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/rescue-clazosentan-for-symptomatic-cerebral-vasospasm-following-subarachnoid-hemorrhage-due-to-anterior-cranial-fossa-dural-arteriovenous-fistula-a-case-report-with-serial-angiographic-evaluation\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,26]]},"references-count":26,"alternative-id":["10.25259\/SNI_471_2026"],"URL":"https:\/\/doi.org\/10.25259\/sni_471_2026","relation":{},"ISSN":["2152-7806","2229-5097"],"issn-type":[{"value":"2152-7806","type":"electronic"},{"value":"2229-5097","type":"print"}],"subject":[],"published":{"date-parts":[[2026,6,26]]},"article-number":"367"}}