Endovascular management for intracranial ruptured aneurysms in elderly patients: outcome and technical aspects

Abstract

The definition of an elderly person is debateable; however, age is a recognised negative prognostic factor for outcome after subarachnoid haemmorrhage, and the age cut-off of 60 years is accepted to define a high risk population. The goal of this article is to access the outcome in this precise population of patients that underwent endovascular treatment (EVT) after aneurysm rupture. Forty-two patients (mean age = 70.24) had 40 aneurysms located at the anterior circulation and nine at the posterior circulation. Thirty-seven (87.9%) patients had Fisher III or IV. Forty-six (93.8%) aneurysms were smaller than 15 mm. Twenty-eight (66.7%) patients were in good neurological state on admission (Hunt and Hess I-III) and 14 (33.3%) in poor state. Satisfactory occlusion rate (total occlusion or neck flow) was achieved in 75% of patients. Follow-up was available in 19 (43.18%) out of the 44 aneurysms treated. Aneurysm recanalization was disclosed in three cases. Satisfactory outcome was achieved on: 60.7% of good grades, 21.4% of poor grades, 43.7% of patients with and 57.6% of patents without comorbidites. Fisher grade (P = 0.0346), comorbidities (P = 0.525) and risk factors (P = 0.515) were not associated with clinical outcome. No age cut-off (65,70 and 75) for favourable outcome could be established, P-values were 0.723, 0.741 and 0.738, respectively. Advancing of age was not associated with an increase number of unfavourable outcome (P = 0.125). Poor neurological status on admission was the only variable associated with unfavourable outcome (P = 0.02). Mortality and morbidity rate related to the procedure were 4.8% and 9.5% respectively. Age should not be taken alone for precluding treatment in ruptured aneurysms, EVT can be considered as a first therapeutic option for elderly persons, since an overall favourable outcome could be achieved in most cases, mainly in non-comatose patients.

Safety and Efficacy of Adjunctive Balloon Remodeling during Endovascular Treatment of Intracranial Aneurysms: A Literature Review

“…Twenty-three articles, 2,7,8,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] with 867 traditionally coiled and 273 balloon-assisted procedures met inclusion criteria for thromboembolism analysis, and 21 articles 10,12-31 with 993 traditionally coiled and 170 balloon-assisted procedure aneurysms were eligible based on inclusion criteria for perforation analysis. For the thromboembolism analysis, 12 articles contained cases exclusively treated by traditional-unassisted coiling, 6 articles described results for cases exclusively using balloon remodeling, and 5 reports provided relevant information for both unassisted and balloon remodeling cases, henceforth referred to as "mixed" reports.…”

“…Ten articles 2,13,14,[16][17][18]22,23,26,28 provided sufficient information on the degree of initial occlusion. Follow-up information was available in 11 articles.…”

Endovascular Treatment for Unruptured Intracranial Aneurysms in Elderly Patients: Single-Center Report

“…In many developed countries, SAH after of 70 years of age has been a frequent pathology. 1,2,15,16,21,23,30,32,33 Some authors believe that there is not a persistent increase of rupture risk. They argue that a maximum level is reached by the age of 70 years, and then a decrease is expected.…”

“…Procedural morbidity has also been decreasing. 14,15,[19][20][21][23][24][25] In addition, unlike open surgery, endovascular morbidity and mortality seem to be less dependent on a patient's age. 11,31,34 Our series demonstrated that endovascular coiling of elderly patients with unruptured intracranial aneurysms is safe and effective.…”

“…Endovascular coiling has allowed us to treat more patients, including elderly individuals, in whom surgical clipping is considered risky. [19][20][21][22][23][24][25] Nevertheless, few studies 26 assessing the results of endovascular treatment for unruptured intracranial aneurysms in elderly patients have been undertaken, and optimal management of patients with unruptured intracranial aneurysms and the feasibility and the effectiveness of embolization are yet to be determined. We present our single-center experience of endovascular treatment in patients 70 years of age and older.…”