Clinical Outcomes of Clipping and Coiling in Elderly Patients with Unruptured Cerebral Aneurysms: a National Cohort Study in Korea

Abstract

Background We aimed to analyze outcomes of clipping and coiling in treating unruptured intracranial aneurysms (UIAs) in elderly patients and to identify the age at which perioperative risk increases based on national cohort data in South Korea. Methods The incidence of perioperative intracranial hemorrhage (ICRH), perioperative cerebral infarction (CI), mortality, and moderate to severe disability data of the patients who underwent coiling or clipping for UIAs were retrieved. Estimated breakpoint (EBP) was calculated to identify the age at which the risk of treatment increases. Results A total of 38,207 patients were treated for UIAs. Among these, 22,093 (57.8%) patients underwent coiling and 16,114 (42.2%) patients underwent clipping. The incidence of ICRH, requiring a secondary operation, within 3 months in patients ≥ 65 years that underwent coiling and clipping was 1.13% and 4.81%, respectively, and that of both groups assessed were significantly higher in patients ≥ 75 years (coiling, P = 0.013, relative risk (RR) 1.81; clipping, P = 0.015) than younger patients. The incidence of CI within 3 months in patients aged ≥ 65 was 13.90% and 9.19% in the coiling and clipping groups, respectively. The incidence of CI after coiling in patients aged ≥ 75 years ( P < 0.001, RR 1.96) and after clipping in patients aged ≥ 70 years ( P < 0.001, RR 1.76) was significantly higher than that in younger patients. The mortality rates within 1 year in patients with perioperative ICRH or CI were 2.41% and 3.39% for coiling and clipping groups, respectively, in patients ≥ 65. These rates increased significantly at age 70 in the coiling group and at age 75 for the clipping group ( P = 0.012 and P < 0.001, respectively). Conclusion The risk of treatment increases with age, and this risk increases dramatically in patients aged ≥ 70 years. Therefore, the treatment decisions in patients aged ≥ 70 years should be made with utmost care.

Clinical Outcomes of Coil Embolization for Unruptured Intracranial Aneurysms Categorized by Region and Hospital Size : A Nationwide Cohort Study in Korea

“…As a result, the morbidity and mortality rates were 0.38% and 1.16%, respectively. Although this was an improvement in the clinical outcomes of CE for UIAs from 2006 to 2008 in Korea, the incidence of procedure-related CI in Korea was higher than that reported in previous literature [ 14 ]. As the results of this study show, from 2013 to 2018, the number of hospitals equipped for CE procedures increased by 1.69 times, of which GHs increased by 1.53 times and sGHs increased by 2.18 times.…”

“…In 2021, a study analyzing treatment outcomes in the entire Korean population with UIAs was published [ 14 ], and it was reported that the rate of complications was higher than that reported in other existing studies. It was hypothesized the quality of treatment decreased because of the rapid increase in the number of hospitals equipped for CE in recent years, and it was also hypothesized that the variation in treatment experience by region and hospital size also affected treatment quality [ 5 , 7 , 28 ].…”

Complex networks approach to study comorbidities in patients with unruptured intracranial aneurysms

“…For example, the discovered connectivity between chronic obstructive pulmonary diseases and UIA in women older than 60 years can direct a diagnostic workout toward identifying hidden subclinical forms of COPD in non-smoking aneurysm carries in the respective age. The previous paradigm of age limitation (not older than 65 years) in selection cases for an active treatment of UIA currently is shifting toward higher age limits and is more dependent on the patient’s co-morbidities, functional status, and local life-expectancy rates 21 . The sets of co-morbidities discovered in our age and gender stratified networks may help in the prediction of health status and phenotypical changes in UIA patients even in the long run, thus helping to optimize a timing of active treatment.…”

Clinical characteristics of intracranial aneurysms in elderly patents over 70 years old: a retrospective observational study

“…IAs in the elderly population are not very well documented due to a lack of large-sample studies. In addition, existing studies have mainly focused on patients with unruptured aneurysms [6][7][8][9]. Subsequently, the overall characteristics of IAs in elderly patients remain unclear.…”