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To the Editor:With great interest I have read the recent meta-analysis on the effect of endothelin-receptor antagonists (ETRAs) in patients with aneurysmal subarachnoid hemorrhage.1 Because endothelin might have an important function in the pathogenesis of radiographic vasospasm, ETRAs are presently under intensive investigation in this group of patients. Recently, the results of a large double-blind, placebo-controlled Phase II study (Clazosentan to Overcome Neurological Ischemia and Infarction Occurring After Subarachnoid Hemorrhage [CONSCIOUS-1]) investigating the effect of the ETRA clazosentan in patients with aneurysmal subarachnoid hemorrhage for the first time revealed a 65% relative risk reduction (95% CI, 47% to 78%) of angiographically demonstrated vasospasm in the group of patients treated with the highest dose of clazosentan (15 mg/h).2 This finding was impressive, because no other drug ever before was found …

Effect of Endothelin-Receptor Antagonists on Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage Remains Unclear