{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T10:25:38Z","timestamp":1787653538234,"version":"build-2736575974"},"reference-count":18,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Poor-grade aneurysmal subarachnoid hemorrhage (SAH; WFNS grades 4\u20135) carries a historically dismal prognosis, driven by early brain injury and delayed cerebral ischemia (DCI). Despite advances in neurocritical care, effective pharmacological strategies for this vulnerable population remain limited. This multicenter study investigated prognostic factors for functional recovery, with particular emphasis on the potential benefit of adjunctive cilostazol, a phosphodiesterase-3 inhibitor with vasodilatory and antiplatelet properties. Methods: This multicenter retrospective cohort study analyzed 394 patients with WFNS grade 4\u20135 aneurysmal SAH treated at 10 institutions between 2018 and 2024. The primary outcome was favorable functional status (modified Rankin Scale 0\u20132) at 6 months. Multivariable logistic regression was performed to identify independent predictors of outcome. Sensitivity analyses were also performed to assess the potential influence of missing 6-month outcome data. Results: Six-month outcomes were available for 318 patients (80.7%), of whom 107 (33.6%) achieved favorable recovery. Patients with favorable outcomes were significantly more likely to have received cilostazol than those with unfavorable outcomes (70.1% vs. 55.5%; p = 0.016). In multivariable logistic regression, cilostazol use remained associated with a favorable outcome (odds ratio [OR] 2.29; 95% confidence interval [CI] 1.01\u20135.22; p = 0.048) after adjustment for age (OR 0.95; p &lt; 0.001), WFNS grade 5 (OR 0.46; p = 0.012), ventricular drainage, and cerebral infarction. Sensitivity analyses, including propensity score\u2013weighted and missing-outcome analyses, yielded directionally favorable estimates but were not statistically significant. Conclusions: Despite the severity of the initial insult, one-third of patients with available 6-month follow-up achieved functional independence. Cilostazol use was associated with favorable functional outcome in the primary analysis, although statistical significance was not retained in sensitivity analyses addressing missing outcomes. These findings suggest a potential therapeutic signal of cilostazol in poor-grade aneurysmal SAH, warranting prospective validation.<\/jats:p>","DOI":"10.3390\/jcm15166386","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:12:11Z","timestamp":1787069531000},"page":"6386","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cilostazol and Functional Outcomes in Poor-Grade Aneurysmal Subarachnoid Hemorrhage: A Multicenter Retrospective Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4931-0646","authenticated-orcid":false,"given":"Jin","family":"Kikuchi","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Kurume University School of Medicine, Kurume 830-0011, Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7578-4247","authenticated-orcid":false,"given":"Yusuke","family":"Otsu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kurume University School of Medicine, Kurume 830-0011, Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5847-4573","authenticated-orcid":false,"given":"Sosho","family":"Kajiwara","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kurume University School of Medicine, Kurume 830-0011, Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimihiko","family":"Orito","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kurume University School of Medicine, Kurume 830-0011, Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaru","family":"Hirohata","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kurume University School of Medicine, Kurume 830-0011, Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2019-1732","authenticated-orcid":false,"given":"Kiyohiko","family":"Sakata","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kurume University School of Medicine, Kurume 830-0011, Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katsumi","family":"Takizawa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Japanese Red Cross Asahikawa Hospital, Asahikawa 070-0061, Hokkaido, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2433-924X","authenticated-orcid":false,"given":"Yoji","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kyorin University School of Medicine, Mitaka 181-8611, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaki","family":"Chin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki 710-0052, Okayama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Kurita","sequence":"additional","affiliation":[{"name":"Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka 350-1298, Saitama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1826-1914","authenticated-orcid":false,"given":"Akihiro","family":"Hirayama","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tokai University School of Medicine, Isehara 259-1193, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koreaki","family":"Irie","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Japan Red Cross Medical Center, Shibuya-ku 150-8935, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0147-5564","authenticated-orcid":false,"given":"Kenichiro","family":"Suyama","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Fujita Health University, Toyoake 470-1192, Aichi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ichiro","family":"Nakahara","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Fukuoka Shin Mizumaki Hospital, Onga 807-0051, Fukuoka, 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 734-0037, Hiroshima, 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, Fukuoka, 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 Central Hospital, Izumo 693-8555, Shimane, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"ref_1","first-page":"e314","article-title":"2023 Guideline for the Management of Patients with Aneurysmal Subarachnoid Hemorrhage","volume":"54","author":"Hoh","year":"2023","journal-title":"Stroke"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1007\/s12028-016-0305-3","article-title":"Functional Outcome after Poor-Grade Subarachnoid Hemorrhage: A Single-Center Study and Systematic Literature Review","volume":"25","author":"Mansur","year":"2016","journal-title":"Neurocrit. 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Neurosurg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6386\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T10:12:44Z","timestamp":1787652764000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6386"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,18]]},"references-count":18,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15166386"],"URL":"https:\/\/doi.org\/10.3390\/jcm15166386","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,18]]}}}