Ogasawara Kuniaki, Yamadate Keiko, Kobayashi Masakazu, Endo Hidehiko, Fukuda Takeshi, Yoshida Kenji, Terasaki Kazunori, Inoue Takashi, Ogawa Akira
Department of Neurosurgery, Iwate Medical University, Morioka 020-8505, Japan.
Surg Neurol. 2005 Oct;64(4):309-13; discussion 313-4. doi: 10.1016/j.surneu.2005.01.008.
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.
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.
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.
Pretreatment with edaravone can prevent development of cognitive impairment after CEA.
一些接受颈动脉内膜切除术（CEA）的患者会出现术后认知功能障碍。本项采用历史对照的病例队列研究旨在确定新型自由基清除剂依达拉奉预处理是否能预防CEA术后认知功能障碍的发生。
55例同侧颈内动脉（ICA）狭窄（≥70%）患者在夹闭ICA前接受依达拉奉治疗后行CEA。术前及术后第1个月进行神经心理学测试。在CEA术前、术后即刻及术后第3天使用单光子发射计算机断层扫描测量脑血流量。
仅1例（2%）患者出现术后认知功能障碍，该患者表现为术后脑血流灌注过度（脑血流量较术前值增加≥100%）。对照组（92例未使用依达拉奉的CEA患者）术后认知功能障碍的发生率显著更高（12%）（P = 0.0298，对照组 vs 治疗组）。逻辑回归分析表明，术后脑血流灌注过度和未使用依达拉奉预处理是术后认知功能障碍的显著独立预测因素。
依达拉奉预处理可预防CEA术后认知功能障碍的发生。
