Background and purpose The association between age and outcomes following aneurysm treatment with flow diverters such as the Pipeline Embolization Device (PED) have not been well established. Using the International Retrospective Study of the Pipeline Embolization Device (IntrePED registry, we assessed the age-related clinical outcomes of patients undergoing aneurysm embolization with the PED.
Materials and methods IntrePED registry unruptured aneurysm patients were divided into four age groups: ≤50, 51–60, 61–70 and. >70 years old. The rates of the following post-operative complications were compared between age groups using chi-squared tests: spontaneous rupture, intracranial hemorrhage, ischemic stroke, parent artery stenosis, cranial neuropathy, neurological morbidity, neurological mortality, combined neurological morbidity and mortality and all-cause mortality. The association between age and these complications was tested in a multivariate logistic regression analysis adjusting for sex, number of PEDs, aneurysm size, location and type.
Results 711 patients with 820 unruptured aneurysms were included in this study. Univariate analysis demonstrated no significant difference in intracranial hemorrhage rates across age groups (lowest 1.0% for patients≤50 and highest 4.1% for patients >70, P = 0.21). There was no difference in ischemic stroke rates (lowest 3.6% for patients≤50 and highest 6.0% for patients 50–60, P = 0.72). Age >70 years old was associated with higher rates of neurological mortality as patients >70 years old had neurological mortality rates of 7.4% compared to 3.3% for patients 61–70, 2.7% for patients 51–60 and 0.5% for patients≤50 years old (P = 0.006). On multivariate logistic regression analysis, increasing age was associated with a higher odds of combined neurological morbidity and mortality (OR = 1.02, 95% CI = 1.00–1.05, P = 0.03).
Conclusions Increasing age is associated with higher neurological morbidity and mortality after Pipeline embolization of intracranial aneurysms. However, the overall complication rates of PED treatment in select elderly patients (>70) were acceptably low suggesting that age alone should not be considered an exclusion criteria when considering treatment of intracranial aneurysms with PED.
Disclosures W. Brinjikji: None. D. Kallmes: 1; C; Covidien. H. Cloft: None. G. Lanzino: 2; C; Covidien.
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