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Endovascular treatment of unruptured intracranial aneurysms in the elderly: analysis of procedure related complications
  1. M F Stiefel1,
  2. M S Park2,
  3. C G McDougall3,
  4. F C Albuquerque3
  1. 1Department of Neurosurgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA
  2. 2Division of Neurosurgery, University of California, San Diego, California, USA
  3. 3Division of Neurological Surgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
  1. Correspondence to Dr F C Albuquerque, c/o Neuroscience Publications, Barrow Neurological Institute, 350 W Thomas Road, Phoenix, AZ 85013, USA; neuropub{at}chw.edu

Abstract

Introduction The management of unruptured intracranial aneurysms in the elderly remains controversial. Treatment risks are thought to be higher in this group. Large series assessing endovascular treatment of unruptured intracranial aneurysms in the elderly are lacking. Our single center endovascular experience in treating unruptured intracranial aneurysms in the elderly is presented.

Methods 77 patients, 70 years or older, were referred to the endovascular neurosurgery service for treatment of an unruptured intracranial aneurysm between February 2000 and May 2008. Hospital records, operative reports, angiograms and radiology reports were reviewed and analyzed retrospectively.

Results 99 aneurysms were treated in 77 patients in 102 procedures. Mean patient age was 75±4 years, and the average aneurysm size was 11±7 mm. Adjuvant techniques were used in 66% of cases. Endovascular procedures included coiling alone (32%), balloon assisted coiling (19%), stent assisted coiling (37%), balloon assisted stent and coiling (8%), stent only (1%) and glue (2%). The permanent morbidity and mortality rates were 1% and 3%, respectively. Four adverse events were attributed to the patient's age. Posterior circulation aneurysms were associated with more adverse events (41%) than anterior circulation aneurysms (14%). Endovascular treatments using adjuvant techniques were associated with a higher complication rate than coiling alone.

Conclusions With only a 4% permanent rate of neurological morbidity and mortality, endovascular treatment of unruptured aneurysms can be performed safely in the elderly. Age should not be the limiting factor when considering endovascular therapy.

  • Aneurysm
  • Coil

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Footnotes

  • Table 4 is published online only at http://jnis.bmj.com/content/volXX/issueX

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the hospital's internal review board.

  • Provenance and peer review Not commissioned; not externally peer reviewed.

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