Perindopril and residual chronic subdural hematoma volumes six weeks after burr hole surgery: A randomized trial

• Randomized clinical trial combined with retrospective cohort study.
• No effect of perindopril on reducing remnant chronic subdural hematoma after surgical evacuation.
• No effect of ACE inhibitors in general on reducing the frequency of chronic subdural hematoma recurrence.

ObjectiveRecurrence rates of between 5% and 25% have been reported following surgery for chronic subdural hematoma (CSH). A previous study showed that the treatment with angiotensin converting enzyme (ACE) inhibitors decreases the risk of recurrence. To test the effects of ACE inhibitors on the recurrence CSH and CSH remnant six weeks after surgery, we conducted a prospective double-blinded randomized controlled clinical trial on patients with CSHs from July 2009 until October 2012.Patients and methodsPatients eligible for burr hole surgery for CSH were randomized into either an ACE inhibitor perindopril 5 mg or placebo treatment daily for three months prior to surgery. Cerebral CT scans were performed after six weeks, and clinical follow-ups were performed three months after surgery. Additionally, a retrospective analysis of the data and CT scans from all nonrandomized patients from the same time period was performed.ResultsForty-seven patients were included in the randomized study. The patients’ preoperative Glasgow Coma Scale scores were 15. None of the patients in the randomized group developed a recurrence after surgery. Measurements of the sizes of the CSH before and six weeks after surgery revealed no difference between the placebo and perindopril-treated groups. In the retrospective group (245 patients), there was no correlation between the risk of recurrence and ACE inhibitor treatment.ConclusionOur data suggest that perindopril does not diminish the size of residual CSHs six weeks after burr hole surgery and that ACE inhibitors do not decrease the risk of CSH recurrence.