{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T16:46:55Z","timestamp":1788281215167,"version":"build-2803163510"},"reference-count":17,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,6,10]],"date-time":"2025-06-10T00:00:00Z","timestamp":1749513600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Japan Society for the Promotion of Science Grant-in-Aid for Scientific Research (C)","award":["23K08521"],"award-info":[{"award-number":["23K08521"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Since clazosentan was approved for insurance coverage in Japan, the postoperative management of delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) has changed as each facility gains experience. Here, we investigate the prevention, treatment, and management of DCI after SAH throughout Japan in 2023. Methods: In 2024, we conducted an anonymous questionnaire survey\u2014emailed to certified neurosurgeons in hospitals across Japan\u2014regarding management for preventing DCI after aneurysmal SAH. Of them, 78 hospitals responded and were included in this study. These results were compared with the findings of a survey conducted prior to the approval of clazosentan in Japan (2022). Results: The proportion of institutions with a standardized protocol for DCI after aneurysmal SAH at a level of \u226550% was 93.0%. For both craniotomy and endovascular surgery, clazosentan was used most frequently, followed by cilostazol, fasudil, and statins. The most common drug for both direct and endovascular procedures was clazosentan. The predominant reason for discontinuing clazosentan was respiratory complications\u2014such as pulmonary edema\u2014followed by cardiac complications. However, 62.1% of facilities felt that the number of cases wherein clazosentan was discontinued was deceasing. While 77.5% of respondents felt that clazosentan was effective for preventing DCI after aneurysmal SAH, only 49.3% felt that it improved outcomes. Conclusions: Since its approval, clazosentan has been the most common treatment for DCI prevention after aneurysmal SAH. The impression of the effectiveness in preventing DCI and the outcomes of clazosentan have been mixed. As data accumulate, clazosentan use and management protocols will be refined and developed.<\/jats:p>","DOI":"10.3390\/jcm14124107","type":"journal-article","created":{"date-parts":[[2025,6,10]],"date-time":"2025-06-10T08:18:43Z","timestamp":1749543523000},"page":"4107","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Japanese Nationwide Questionnaire Survey on the Treatment and Management of Subarachnoid Hemorrhage Due to Ruptured Cerebral Aneurysm"],"prefix":"10.3390","volume":"14","author":[{"given":"Toshikazu","family":"Hidaka","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Shimane Prefectural Hospital, Izumo 693-0068, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junichiro","family":"Ochiai","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Shimane Prefectural Hospital, Izumo 693-0068, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Inoue","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Shimane Prefectural Hospital, Izumo 693-0068, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuichiro","family":"Kawamoto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Shimane Prefectural Hospital, Izumo 693-0068, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobutaka","family":"Horie","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Nishikawa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagoya City University Graduate School of Medical Science, Nagoya 467-8601, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuhito","family":"Mase","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagoya City University Graduate School of Medical Science, Nagoya 467-8601, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Motohiro","family":"Morioka","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kurume University School of Medicine, Kurume 830-0011, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun C.","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5738-1332","authenticated-orcid":false,"given":"Hiroaki","family":"Shimizu","sequence":"additional","affiliation":[{"name":"Akita Prefectural Hospital Organization, Akita 010-0874, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4205-1490","authenticated-orcid":false,"given":"Fusao","family":"Ikawa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Shimane Prefectural Hospital, Izumo 693-0068, Japan"},{"name":"Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1227\/01.NEU.0000255396.23280.31","article-title":"Predictors of cerebral infarction in patients with aneurysmal subarachnoid hemorrhage","volume":"60","author":"Ferguson","year":"2007","journal-title":"Neurosurgery"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"E175","DOI":"10.1093\/neuros\/nyz340","article-title":"Delayed cerebral infarction is systematically associated with a cerebral vasospasm of large intracranial arteries","volume":"86","author":"Brami","year":"2020","journal-title":"Neurosurgery"},{"key":"ref_3","first-page":"e314","article-title":"2023 Guideline for the management of patients with aneurysmal subarachnoid hemorrhage: A guideline from the American Heart Association\/American Stroke","volume":"54","author":"Hoh","year":"2023","journal-title":"Stroke"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1177\/17474930221090347","article-title":"Japan Stroke Society Guideline 2021 for the Treatment of Stroke","volume":"17","author":"Miyamoto","year":"2022","journal-title":"Int. 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Care"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/12\/4107\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:49:26Z","timestamp":1760032166000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/12\/4107"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,10]]},"references-count":17,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["jcm14124107"],"URL":"https:\/\/doi.org\/10.3390\/jcm14124107","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,10]]}}}