Effects of the free radical scavenger, edaravone, on the development of postoperative cognitive impairment in patients undergoing carotid endarterectomy.
BACKGROUND
Some patients undergoing carotid endarterectomy (CEA) experience postoperative cognitive impairment. The purpose of the present case cohort study with historical control was to determine whether pretreatment with a novel free radical scavenger, edaravone, could prevent development of cognitive impairment after CEA.


METHODS
Fifty-five patients with ipsilateral internal carotid artery (ICA) stenosis (> or =70%) underwent CEA with administration of edaravone before ICA clamping. Neuropsychological testing was performed preoperatively and at the first postoperative month. Cerebral blood flow was also measured using single-photon emission computed tomography before and immediately after CEA and on the third postoperative day.


RESULTS
Postoperative cognitive impairment was observed in only 1 (2%) patient, who exhibited postoperative cerebral hyperperfusion (cerebral blood flow increase > or =100% compared with preoperative values). Incidence of postoperative cognitive impairment in the control group (92 CEA patients without administration of edaravone) was significantly higher (12%) (P = .0298, control vs treatment group). Logistic regression analysis demonstrated that postoperative cerebral hyperperfusion and absence of pretreatment with edaravone were significant independent predictors of postoperative cognitive impairment.


CONCLUSIONS
Pretreatment with edaravone can prevent development of cognitive impairment after CEA.
Ogasawara
Kuniaki
K
Department of Neurosurgery, Iwate Medical University, Morioka 020-8505, Japan. kuogasa@iwate-med.ac.jp
Yamadate
Keiko
K
Kobayashi
Masakazu
M
Endo
Hidehiko
H
Fukuda
Takeshi
T
Yoshida
Kenji
K
Terasaki
Kazunori
K
Inoue
Takashi
T
Ogawa
Akira
A
D000368:Aged; D000983:Antipyrine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D002343:Carotid Artery, Internal / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D016893:Carotid Stenosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D002544:Cerebral Infarction / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D002560:Cerebrovascular Circulation / Q000187:drug effects / Q000502:physiology; D003072:Cognition Disorders / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D015331:Cohort Studies; D000077553:Edaravone; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D016166:Free Radical Scavengers / Q000627:therapeutic use*; D006801:Humans; D002534:Hypoxia, Brain / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D020925:Hypoxia-Ischemia, Brain / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
D016166:Free Radical Scavengers; D000077553:Edaravone; D000983:Antipyrine