Dosage used in the study:
- intraoperative and postoperative IV minocycline hydrochloride (200 mg/d) until 4 days after surgery
- semisynthetic tetracycline
- clinically used as an antibiotic and anti-inflammatory drug
- neuroprotective potential reported in animal models of cerebral ischemia
- reduces infarction size in rats due to the prevention of inflammatory reactions by suppressing microglial activation, down-regulating proinflammatory cytokines, and blocking MMP expression
- prevents reperfusion-related ICH by blocking MMP-9 in mice
- neuroprotective role as an antiapoptotic agent and antioxidant
- Mechanism in ischemia-reperfusion injury
- maintains BBB? –> reducing risk of vasogenic edema and hemorrhagic convesrion?
- Moyamoya patients have higher expression of MMP-9 –> can perioperative minocycline prevent surgical complications (cerebral hyperperfusion or ischemia)
- Minocycline blocks MMP-9, prevents neurological deterioration due to cerebral hyperperfusion.
- Minocycline compensated for deleterious effect of BP lowering by protecting contralateral and/or remote brain
Higher risk of reperfusion injury in Moyamoya due to
- poor network formation of pial arteries –> poorer hemodyamic distribution after revascularization
- fragile peripheral pial artery (thin media and internal elastic lamina) in Moyamoya disease
- increased expression of VEGF and MMP-9
The administration of minocycline in combination with strict blood pressure control could represent secure and effective postoperative management for the prevention of symptomatic CHP after STA-MCA anastomosis for MMD.
- small number of patients who developed focal deficits
- heterogenous group
- no data on preoperative hemodynamic status – no SPECT stress testing
- CBF studies performed under different institutions
- did not measure MMP-9 levels
Fujimura, Miki et al. “Minocycline Prevents Focal Neurological Deterioration Due To Cerebral Hyperperfusion After Extracranial-Intracranial Bypass For Moyamoya Disease”. Neurosurgery74.2 (2014): 163-170.