Free radical scavenger, edaravone, in stroke with internal carotid artery occlusion

• Published in: Journal of the neurological sciences Vol. 221; no. 1; pp. 11 - 17
• Main Authors: Toyoda, Kazunori, Fujii, Kenichiro, Kamouchi, Masahiro, Nakane, Hiroshi, Arihiro, Shoji, Okada, Yasushi, Ibayashi, Setsuro, Iida, Mitsuo
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier B.V 15-06-2004; Elsevier Science
• Subjects: Aged; Antipyrine - administration & dosage; Antipyrine - analogs & derivatives; Antipyrine - therapeutic use; Atrial Fibrillation - complications; Biological and medical sciences; Brain edema; Brain Edema - drug therapy; Brain infarction; Carotid Artery Thrombosis - drug therapy; Carotid Artery Thrombosis - mortality; Carotid Artery, Internal; Cerebral Infarction - drug therapy; Cerebral Infarction - mortality; Cerebral Infarction - pathology; Cohort Studies; Female; Free Radical Scavengers - therapeutic use; Functional Laterality; Hemorrhagic transformation; Humans; Infusions, Intravenous; Male; Medical sciences; Neurology; Neuroprotective agent; Risk Factors; Stroke management; Stroke outcome; Survival Analysis; Treatment Outcome; Stroke management; Stroke outcome; Brain edema; Hemorrhagic transformation; Neuroprotective agent; Brain infarction; Stroke; Internal carotid; Nervous system diseases; Prognosis; Infarct; Cardiovascular disease; Hemorrhage; Radical scavenger; Free radical; Cerebral disorder; Vascular disease; Clinical management; Central nervous system disease; Edaravone; Artery occlusion; Cerebral edema; Cerebrovascular disease
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2004.03.002

Background: Edaravone has potent free radical quenching and antioxidant actions. The agent has been recently in commercial use for acute ischemic stroke patients. In this study, we investigated the therapeutic effect of edaravone on severe carotid-territorial stroke.
Methods: Stroke patients with internal carotid artery occlusion and baseline NIH Stroke Scale Score ≥15 were treated for 14 days with drip intravenous infusion of edaravone (
n=30) and were compared with a historical control cohort of similar patients (
n=31). Glycerol was also administered to all patients in both groups.
Results: Infarct volume (
P<0.02) and midline shift (
P<0.02) on CT performed on day 2 of the patients treated with edaravone were smaller than those without edaravone. For patients with edaravone, infarct volume (
P<0.0001) and midline shift (
P<0.0001) on days 5–7 were greater than those on day 2. Hemorrhagic transformation of infarcts on day 2 was less severe in patients with than without edaravone (
P<0.03). Within 14 days after the onset of stroke, 6 patients with edaravone (20%) and 14 without edaravone (45%) died directly of stroke (
P<0.03). Among all patients, only two treated with edaravone were independent without any assistance 8 weeks after the onset.
Conclusions: Edaravone was associated with delayed evolution of infarcts and edema in patients with severe carotid-territorial stroke and decreased mortality during the acute stage. The agent, however, failed to prevent evolution of infarcts and edema on later days, and did not significantly improve functional outcome among the surviving patients.