Pretreatment with the free radical scavenger edaravone prevents cerebral hyperperfusion after carotid endarterectomy
Pretreatment with the free radical scavenger edaravone prevents cerebral hyperperfusion after carotid endarterectomy
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DOI：
10.1227/01.neu.0000140838.27450.63
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发表时间：
2004-11-01
期刊：
影响因子：
4.8
通讯作者：
Ogawa, A
中科院分区：
文献类型：
--
作者：
Ogasawara, K;Inoue, T;Ogawa, A
目的：颈动脉内膜切除术（CEA）后脑高灌注综合征是一种罕见但具有潜在破坏性的并发症。本研究不是一项随机对照试验，而是一项具有历史对照的病例队列研究，目的是确定用一种新型自由基清除剂依达拉奉预处理是否可以预防CEA后脑过度灌注的发生。方法：50例同侧颈内动脉狭窄患者（大于或等于70%）在颈内动脉夹持前行CEA合并依达拉奉。术前用单光子发射计算机断层扫描（spect）评估脑血流和脑血管对乙酰唑胺的反应性（CVR）。脑。在CEA后立即和术后第3天测量血流量。结果：只有1例（2%）患者在CEA后立即行SPECT显示脑高灌注（脑血流量增加大于或等于术前值的100%），同时也表现出术前CVR降低。对照组（51例未使用依达拉奉的CEA患者）经spect显示CEA后高灌注的发生率明显高于对照组。（16%） （P = 0.0310，对照组与治疗组比较）。此外，在术前CVR降低的患者亚组中，经SPECT检查，依达拉奉组cea后高灌注发生率（7%）明显低于对照组（67%）（P = 0.0029）。Logistic回归分析显示，SPECT显示术前CVR降低和未使用依达拉奉预处理是cea后高灌注的重要独立预测因素。结论：依达拉奉预处理可预防CEA术后脑高灌注的发生。
OBJECTIVE: Cerebral hyperperfu'sion syndrome after carotids endarterectomy (CEA) isa 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 (greater than or equal to70%) 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 ASPECT). Cerebral. blood flow also was measured immediately after CEA and on the 3rd postoperative day.RESULTS: Cerebral, hyperperfusion (cerebral blood flow increase greater than or equal to100% 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.