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

  • Interventional Neuroradiology
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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.

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Acknowledgements

We are grateful to J.-N. Vallée for his help with statistical analysis.

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Authors and Affiliations

  1. Interventional Neuroradiology, Centre Hospitalier Louis Pasteur, 39, avenue de la Liberté, 68024, Colmar Cedex, France

    F. Mont’alverne, M. Musacchio, V. Tolentino, C. Riquelme & A. Tournade

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  1. F. Mont’alverne
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  2. M. Musacchio
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  3. V. Tolentino
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  4. C. Riquelme
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  5. A. Tournade
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Correspondence to F. Mont’alverne.

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Mont’alverne, F., Musacchio, M., Tolentino, V. et al. Endovascular management for intracranial ruptured aneurysms in elderly patients: outcome and technical aspects. Neuroradiology 47, 446–457 (2005). https://doi.org/10.1007/s00234-005-1345-0

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