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Pretreatment with the Free Radical Scavenger Edaravone Prevents Cerebral Hyperperfusion after Carotid Endarterectomy

Ogasawara, Kuniaki M.D.; Inoue, Takashi M.D.; Kobayashi, Masakazu M.D.; Endo, Hidehiko M.D.; Fukuda, Takeshi M.D.; Ogawa, Akira M.D.

doi: 10.1227/01.NEU.0000140838.27450.63
Clinical Studies

OBJECTIVE: Cerebral hyperperfusion syndrome after carotid endarterectomy (CEA) is a rare but potentially devastating complication. The purpose of the present study, which was not a randomized controlled trial but a case cohort study with historical control, was to determine whether pretreatment with a novel free radical scavenger, edaravone, could prevent occurrence of cerebral hyperperfusion after CEA.

METHODS: Fifty patients with ipsilateral internal carotid artery stenosis (≥70%) underwent CEA with administration of edaravone before internal carotid artery clamping. Preoperative cerebral blood flow and cerebrovascular reactivity (CVR) to acetazolamide were assessed with single-photon emission computed tomography (SPECT). Cerebral blood flow also was measured immediately after CEA and on the 3rd postoperative day.

RESULTS: Cerebral hyperperfusion (cerebral blood flow increase ≥100% compared with preoperative values) was revealed by SPECT performed immediately after CEA in only one patient (2%), who also exhibited reduced preoperative CVR. The incidence of post-CEA hyperperfusion as revealed by SPECT in the control group (51 CEA patients without administration of edaravone) was significantly higher (16%) (P = 0.0310, control versus treatment group). In addition, in a subgroup of patients with reduced preoperative CVR, the incidence of post-CEA hyperperfusion as revealed by SPECT in the edaravone group (7%) was significantly lower than that in the control group (67%) (P = 0.0029). Logistic regression analysis demonstrated that reduced preoperative CVR and absence of pretreatment with edaravone were significant independent predictors of post-CEA hyperperfusion as revealed by SPECT.

CONCLUSION: Pretreatment with edaravone can prevent occurrence of cerebral hyperperfusion after CEA.

Department of Neurosurgery, Iwate Medical University, Morioka, Japan (Ogasawara, Inoue, Kobayashi, Endo, Fukuda, Ogawa)

Reprint requests: Kuniaki Ogasawara, M.D., Department of Neurosurgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Japan 020-8505. Email: kuogasa@iwate-med.ac.jp

Received, January 14, 2004.

Accepted, June 7, 2004.

Copyright © by the Congress of Neurological Surgeons