Efficacy of pretreatment with the free radical scavenger, edaravone, for prevention of cerebral hyperperfusion after carotid artery stenting: A single-center randomized controlled trial

Optimal therapy to avoid cerebral hyperperfusion (CHP) after carotid artery stenting (CAS) is yet to be established. The purpose of this study was to determine whether pretreatment with a free radical scavenger, edaravone, could prevent CHP after CAS. A prospective, randomized, controlled, single-center trial was conducted between April 2011 and January 2018. Eligible patients were those who underwent CAS. Subjects were randomly assigned to receive (edaravone group) or not receive (control group) administration of edaravone before stent deployment. The primary outcome was occurrence of CHP immediately (within 1 h) after CAS. Cerebral blood flow (CBF) was assessed in the middle cerebral artery (MCA) region and the cerebellar hemisphere using single-photon emission computed tomography (SPECT) before and immediately after CAS. The asymmetry index (AI) (%) was defined as CBF in the affected MCA region divided by CBF in the unaffected MCA region × 100. CHP was defined as AI > 120% immediately after CAS. The trial was stopped ahead of schedule due to poor recruitment. Among 52 participants, 51 completed the trial (edaravone group, n = 25; control group, n = 26). CHP occurred in 2/25 patients (8%) in the edaravone group and in 1/26 patients (4%) in the control group, with no significant difference between the groups (P = 0.610). Pretreatment with edaravone appeared not to be associated with reduction in the occurrence of CHP immediately after CAS.