Development of a Delayed Cerebral Infarction Load Scoring System (DCI Score)

Wong, George Kwok Chu; Nung, Ryan Chi Hang; Sitt, Jacqueline Ching Man; Mok, Vincent Chung Tong; Wong, Adrian; Poon, Wai Sang; Wang, Defeng; Abrigo, Jill; Siu, Deyond Y.W.

doi:10.1007/978-3-030-04615-6_21

Cited by 2 publications

(3 citation statements)

References 12 publications

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“…Morbidity and mortality events including new cerebral infarcts and DINDs are relevant clinical endpoints in patients with aSAH, because both are predictive of cognitive impair-ment and poor functional outcome. [18][19][20][21] These endpoints were objectively evaluated by an independent committee, and their decreased occurrence provides evidence of the efficacy of clazosentan in preventing vasospasm-related ischemic events after aSAH.…”

Section: Discussionmentioning

confidence: 99%

“…With the increased power gained by pooling the two studies, a significant treatment effect could be demonstrated on the reduction of poor outcome assessed by mRS, supporting the argument that a large number of patients would be needed to establish the effect of an antivasospastic drug on long-term outcome. [18][19][20][21] These results suggest a pronounced improvement in clinical outcome with clazosentan despite a significantly decreased need for rescue ther- apy compared with placebo, whereas the higher use of rescue therapy in the placebo group may have contributed to improved outcomes in these patients. 25 Previous studies suggest that poor WFNS grade (≥ III) and the presence of thick and diffuse subarachnoid blood before the securing procedure portend a worse clinical course and outcome in patients with aSAH, 10,11,26 which was confirmed in the current studies.…”

Section: Discussionmentioning

confidence: 99%

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Effects of clazosentan on cerebral vasospasm–related morbidity and all-cause mortality after aneurysmal subarachnoid hemorrhage: two randomized phase 3 trials in Japanese patients

Endo

Hagihara²,

Kimura

et al. 2022

Journal of Neurosurgery

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OBJECTIVE Clazosentan has been investigated globally for the prevention of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH). The authors evaluated its effects on vasospasm-related morbidity and all-cause mortality following aSAH in Japanese patients. METHODS Two similar double-blind, placebo-controlled phase 3 studies were conducted in 57 Japanese centers in patients with aSAH, after aneurysms were secured by endovascular coiling in one study and surgical clipping in the other. In each study, patients were randomly administered intravenous clazosentan (10 mg/hr) or placebo (1:1) starting within 48 hours of aSAH and for up to 15 days after aSAH. Stratified randomization based on World Federation of Neurosurgical Societies grade was performed using a centralized interactive web response system. Vasospasm-related morbidity and all-cause mortality within 6 weeks post-aSAH, including new cerebral infarcts and delayed ischemic neurological deficits as well as all-cause mortality, were the first primary endpoint in each study. The second primary endpoint was all-cause morbidity (new cerebral infarct or delayed ischemic neurological deficit from any causes) and all-cause mortality (all-cause morbidity/mortality) within 6 weeks post-aSAH. The incidence of individual components of the primary morbidity/mortality endpoints within 6 weeks and patient outcome at 12 weeks post-aSAH (including the modified Rankin Scale scores) were also evaluated. The above analyses were also performed in the population pooled from both studies. RESULTS In each study, 221 patients were randomized and 220 were included in the full analysis set of the primary analysis (109 in each clazosentan group, 111 in each placebo group). Clazosentan significantly reduced the incidence of vasospasm-related morbidity and all-cause mortality after aneurysm coiling (from 28.8% to 13.6%; relative risk reduction 53%; 95% CI 17%–73%) and after clipping (from 39.6% to 16.2%; relative risk reduction 59%; 95% CI 33%–75%). All-cause morbidity/mortality and poor outcome (dichotomized modified Rankin Scale scores) were significantly reduced by clazosentan after preplanned study pooling. Treatment-emergent adverse events were similar to those reported previously. CONCLUSIONS Clazosentan significantly reduced the combined incidence of vasospasm-related morbidity and all-cause mortality post-aSAH with no unexpected safety findings. Clinical trial registration nos.: JapicCTI-163368 and JapicCTI-163369 (https://www.clinicaltrials.jp)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effects of clazosentan on cerebral vasospasm–related morbidity and all-cause mortality after aneurysmal subarachnoid hemorrhage: two randomized phase 3 trials in Japanese patients

Endo

Hagihara²,

Kimura

et al. 2022

Journal of Neurosurgery

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show abstract

“…Cerebral infarction, a very common cardiovascular and cerebrovascular disease in clinical practice, refers to damage to a large number of brain tissues and neurons caused by the pathological states of ischemia and hypoxia in brain tissues often due to dramatically reduced blood flow to the brain because of the occlusion of blood vessels to the brain (1,2). Besides, cerebral infarction is one of the most common cardiovascular and cerebrovascular diseases in the elderly and also one of the important causes of vascular dementia, limb dysfunction and death in the elderly.…”

Section: Introductionmentioning

confidence: 99%

MiR-211 represses apoptosis of nerve cells in rats with cerebral infarction through PI3K/AKT signaling pathway

Fang Li,

Hongxin Liu

2023

Cell Mol Biol (Noisy-le-grand)

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Development of a Delayed Cerebral Infarction Load Scoring System (DCI Score)

Cited by 2 publications

References 12 publications

Effects of clazosentan on cerebral vasospasm–related morbidity and all-cause mortality after aneurysmal subarachnoid hemorrhage: two randomized phase 3 trials in Japanese patients

Effects of clazosentan on cerebral vasospasm–related morbidity and all-cause mortality after aneurysmal subarachnoid hemorrhage: two randomized phase 3 trials in Japanese patients

MiR-211 represses apoptosis of nerve cells in rats with cerebral infarction through PI3K/AKT signaling pathway

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