Pretreatment with the free radical scavenger edaravone prevents cerebral hyperperfusion after carotid endarterectomy.
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.


CONCLUSIONS
Pretreatment with edaravone can prevent occurrence of cerebral hyperperfusion after CEA.
Ogasawara
Kuniaki
K
Department of Neurosurgery, Iwate Medical University, Morioka, Japan. kuogasa@iwate-med.ac.jp
Inoue
Takashi
T
Kobayashi
Masakazu
M
Endo
Hidehiko
H
Fukuda
Takeshi
T
Ogawa
Akira
A
D000368:Aged; D000983:Antipyrine / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D001921:Brain / Q000098:blood supply / Q000187:drug effects; D002343:Carotid Artery, Internal / Q000187:drug effects / Q000473:pathology / Q000601:surgery; D016893:Carotid Stenosis / Q000188:drug therapy / Q000601:surgery; D002539:Cerebral Arterial Diseases / Q000517:prevention & control*; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D003131:Combined Modality Therapy / Q000379:methods; D000077553:Edaravone; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D016166:Free Radical Scavengers / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods; D013577:Syndrome
D016166:Free Radical Scavengers; D000077553:Edaravone; D000983:Antipyrine