Edaravone Therapy Could be a Substitute for Decompressive Craniotomy/Craniectomy for Large Ischemic Stroke in Remote Areas with no Neurosurgeons

Seidu A. Richard


The incidence of stroke has been a major task for medics and relatives globally. Stroke is the second most frequent disease with high morbidity as well as mortality worldwide. This is a very short and focus review on edaravone therapy. Due to the success story of edaravone in the management of stroke, it could be beneficial for severe stroke patients. The impact of edaravone was highest in the most severely afflicted stroke patients with National Institutes of Health Stroke Scale (NIHSS) scores ≥15 during admission. Large-artery atherosclerosis or cardioembolism stroke subtypes had the highest NIHSS scores. On the other hand, decompressive craniectomy is the resection of part of the skull so that edematous brain tissue can herniate outside. It is thus advocated that, edaravone therapy could be a substitute for decompressive craniotomy for large ischemic stroke in remote facilities with no neurosurgeons.


Edaravone, Decompressive, Craniotomy, Craniectomy, Stroke

Full Text:



Abe K, Itoyama Y, Sobue G, Tsuji S, Aoki M, Doyu M, et al. Confirmatory double-blind, parallel-group, placebo-controlled study of efficacy and safety of edaravone (MCI-186) in amyotrophic lateral sclerosis patients. Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration 2014;15(7-8):610-617.

Bhatia R, Hill MD, Shobha N, Menon B, Bal S, Kochar P, et al. Low rates of acute recanalization with intravenous recombinant tissue plasminogen activator in ischemic stroke: real-world experience and a call for action. Stroke; a journal of cerebral circulation 2010;41(10):2254-2258.

Enomoto M, Endo A, Yatsushige H, Fushimi K, Otomo Y. Clinical effects of early edaravone use in acute ischemic stroke patients treated by endovascular reperfusion therapy. Stroke; a journal of cerebral circulation 2019;50(3):652-658.

Group EAIS. Effect of a novel free radical scavenger, edaravone (MCI-186), on acute brain infarction. Randomized, placebo-controlled, double-blind study at multicenters. Cerebrovascular diseases (Basel, Switzerland) 2003;15(3):222.

Kaste M, Murayama S, Ford GA, Dippel DW, Walters MR, Tatlisumak T, et al. Safety, tolerability and pharmacokinetics of MCI-186 in patients with acute ischemic stroke: new formulation and dosing regimen. Cerebrovascular diseases 2013;36(3):196-204.

Kobayashi S, Fukuma S, Ikenoue T, Fukuhara S, Kobayashi S, Bank JSD. Effect of Edaravone on Neurological Symptoms in Real-World Patients With Acute Ischemic Stroke: Japan Stroke Data Bank. Stroke; a journal of cerebral circulation 2019:STROKEAHA. 118.024351.

Kolias AG, Kirkpatrick PJ, Hutchinson PJ. Decompressive craniectomy: past, present and future. Nature Reviews Neurology 2013;9(7):405.

Lapchak PA. A critical assessment of edaravone acute ischemic stroke efficacy trials: is edaravone an effective neuroprotective therapy? Expert opinion on pharmacotherapy 2010;11(10):1753-1763.

Mishina M, Komaba Y, Kobayashi S, Tanaka N, Kominami S, Fukuchi T, et al. Efficacy of edaravone, a free radical scavenger, for the treatment of acute lacunar infarction. Neurologia medico-chirurgica 2005;45(7):344-348.

Moussaddy A, Demchuk AM, Hill MD. Thrombolytic therapies for ischemic stroke: Triumphs and future challenges. Neuropharmacology 2018;134:272-279.

Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease and stroke statistics-2016 update a report from the American Heart Association. Circulation 2016;133(4):e38-e48.

Müllges W, Franke D, Reents W, Babin-Ebell J, Toyka KV, Ko N, et al. Effect of a novel free radical scavenger, Edaravone (MCI-186), on acute brain infarction. Cerebrovascular Diseases 2003;15(3):222-229.

Naghavi M, Abajobir AA, Abbafati C, Abbas KM, Abd-Allah F, Abera SF, et al. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet 2017;390(10100):1151-1210.

Pallesen L-P, Barlinn K, Puetz V. Role of Decompressive Craniectomy in Ischemic Stroke. Frontiers in neurology 2018;9.

Sharma P, Sinha M, Shukla R, Garg R, Verma R, Singh M. A randomized controlled clinical trial to compare the safety and efficacy of edaravone in acute ischemic stroke. Annals of Indian Academy of Neurology 2011;14(2):103.

Unno Y, Katayama M, Shimizu H. Does Functional Outcome in Acute Ischaemic Stroke Patients Correlate with the Amount of Free-Radical Scavenger Treatment? Clinical drug investigation 2010;30(3):143-155.

Watanabe K, Tanaka M, Yuki S, Hirai M, Yamamoto Y. How is edaravone effective against acute ischemic stroke and amyotrophic lateral sclerosis? Journal of clinical biochemistry and nutrition 2018:17-62.

Xu J, Wang Y, Wang A, Gao Z, Gao X, Chen H, et al. Safety and efficacy of Edaravone Dexborneol versus edaravone for patients with acute ischaemic stroke: a phase II, multicentre, randomised, double-blind, multiple-dose, active-controlled clinical trial. Stroke and Vascular Neurology 2019:svn-2018-000221.

Yang J, Cui X, Li J, Zhang C, Zhang J, Liu M. Edaravone for acute stroke: meta-analyses of data from randomized controlled trials. Developmental neurorehabilitation 2015;18(5):330-335.

Yoshida H, Yanai H, Namiki Y, Fukatsu‐Sasaki K, Furutani N, Tada N. Neuroprotective effects of edaravone: a novel free radical scavenger in cerebrovascular injury. CNS drug reviews 2006;12(1):9-20.

DOI: https://doi.org/10.7575/aiac.abcmed.v.9n.1p.1


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

2013-2022 (CC-BY) Australian International Academic Centre PTY.LTD.

Advances in Bioscience and Clinical Medicine