An experimental vasodilator alleviates vasospasm but is not associated with better neurological outcomes.
In patients with aneurysmal subarachnoid hemorrhage (SAH), angiographic vasospasm is strongly associated with delayed neurological deterioration and has long been seen as a prime therapeutic target for improving outcomes of SAH. However, the available therapy for vasospasm remains unsatisfactory. Clazosentan, an endothelin receptor antagonist, has shown promising results in phase II studies. Now, in a multicenter, manufacturer-funded trial, investigators randomized 1157 patients with SAH to receive intravenous infusions of clazosentan (5 mg/hour) or placebo within 56 hours of SAH and after surgical aneurysm clipping. Patients who lacked significant clot burdens, who were in profound comas, or who displayed angiographic vasospasm on admissio…