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Is a high initial World Federation of Neurosurgery (WFNS) grade really associated with a poor clinical outcome in elderly patients with ruptured intracranial aneurysms treated with coiling?
  1. Christina Iosif1,
  2. Federico Di Maria1,
  3. Nader Sourour1,
  4. Vincent Degos2,
  5. Fabrice Bonneville3,
  6. Alessandra Biondi4,
  7. Betty Jean5,
  8. Chantal Colonne6,
  9. Aurelien Nouet6,
  10. Jacques Chiras1,
  11. Frédéric Clarençon1
  1. 1Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France
  2. 2Department of Anaesthesiology, Pitié-Salpêtrière University Hospital Paris, France
  3. 3Department of Neuroradiology, University Hospital of Toulouse, France
  4. 4Department of Neuroradiology, University Hospital of Besançon, France
  5. 5Department of Neuroradiology, University Hospital of Clermont-Ferrand, France
  6. 6Department of Neurosurgery, Pitié-Salpêtrière University Hospital, Paris, France
  1. Correspondence to Dr Christina Iosif, Department of Neuroradiology, Pitié-Salpêtrière University Hospital, 47 Bd de l'Hôpital, Paris 75013, France; christina.iosif{at}gmail.com

Abstract

Background Coiling of ruptured intracranial aneurysms in elderly patients remains debatable in terms of technical feasibility and clinical outcome.

Aims In this observational cohort study we aimed to assess the technical feasibility, complication profile and clinical outcomes of elderly patients with subarachnoid hemorrhage (SAH) treated with endovascular therapy.

Methods The study included 59 consecutive patients (47 women) aged ≥70 years (mean age 76 years, range 71–84) admitted to our institution with SAH from January 2002 to July 2011. The patients were treated for 66 aneurysms (regular coiling: n=62 (94%), balloon-assisted technique: n=2 (3%), stent and coil technique: n=2 (3%)). World Federation of Neurosurgery (WFNS) grade at admission was 1 in 13 patients, 2 in 23 patients, 3 in 8 patients, 4 in 11 patients and 5 in 4 patients. We analysed data by univariate and multivariate statistical analyses with an emphasis on the initial clinical situation, complications and clinical outcome.

Results The technical success rate was 98% with a procedure-related deficit rate of 10% and procedure-related death rate of 5%. The Glasgow Outcome Scale score at 6 months was 1 in 15 patients (25.4%), 2 in 8 patients (13.6%), 3 in 14 patients (23.7%), 4 in 11 patients (18.6%) and 5 in 11 patients (18.6%). Patients admitted with a high initial WFNS grade did not differ statistically in terms of clinical outcome. The final clinical outcome was not significantly correlated with age, initial Fisher score or procedure-related complications.

Conclusions Endovascular treatment of elderly patients with ruptured cerebral aneurysms is feasible, safe and beneficial regardless of the presenting WFNS score.

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