<p>Objective clazosentan has been approved in Japan for the prevention of cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage (aSAH) and has contributed to the significant suppression of angiographic vasospasm in clinical practice. We herein report the beneficial effects of clazosentan on the perioperative management of patients with aSAH. Methods The study population comprised 102 consecutive patients with aSAH: 49 received conventional treatment (fasudil with triple-H therapy) before May 2022, and 53 were treated with the current protocol (clazosentan management) thereafter. The factors associated with vasospasm and perioperative management, as well as the implementation status of postoperative rehabilitation, hospitalization and outcomes at discharge were compared. Results the prevalence of angiographic vasospasm was significantly lower in the clazosentan group than in the fasudil group (32.1% vs. 59.2%, p &lt; 0.01). Although the incidence of vasospasm-related DCI and favorable outcomes at discharge tended to be better in the clazosentan group, these differences were not statistically significant. Despite equivalent timing of rehabilitation initiation, sitting training and physiotherapy in the training room were initiated significantly earlier in the clazosentan group than in the fasudil group (6.5 days vs. 10.7 days, p &lt; 0.01; 11.8 days vs. 16.1 days, p &lt; 0.01). Furthermore, the length of hospital stay was significantly shorter in the clazosentan group than in the fasudil group (22.3 days vs. 29.6 days, p &lt; 0.01). Conclusion clazosentan-based management was associated with reduced angiographic vasospasm, earlier rehabilitation, and shorter hospitalization compared with fasudil-based management.</p>