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.
Similar content being viewed by others
References
Gorman M (1999) Development and the rights of older people. In: Randel J et al. (eds) The ageing and development report: poverty, independence and the world’s older people. Earthscan Publications, London, pp 3–21
Glascock AP, Feinman SL (1980) A holocultural analysis of old age. Comp Soc Res 3:311–332
Roebuck J (1979) When does old age begin?: the evolution of the English definition. J Soc Hist 12(3):416–428
Thane P (1978) The muddled history of retiring at 60 and 65. New Soc 45(826):234–236
Thane P (1989) History and the sociology of ageing. Soc Hist Med 2(1):93–96
Lanzino G, Kassell NF, Germanson TP, Kongable GL, Truskowski LL, Torner JC, Jane JA (1996) Age and outcome after aneurysmal subarachnoid hemorrhage: why do older patients fare worse?. J Neurosurg 85:410–418
Fisher CM, Kistler JP, Davis JM (1980) Relation of cerebral vasoespasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6:1–9
Hunt WE, Hess RM (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:14–20
Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. Lancet 1:480–484
Mont’Alverne V, Tournade A, Riquelme C, Musacchio M (2002) Multiple aneurysms: endovascular treatment and angiographic study. Interv Neuroradiol 8:95
Inagawa T, Ishikawa S, Aoki H, Takahashi M, Yoshimoto H (1988) Aneurysmal subarachnoid hemorrhage in Izumo City and Shimane prefecture of Japan: incidence. Stroke 19:170–175
Bonita R, Beaglehole R, North JDK (1983) Subarachnoid haemorrhage in New Zealand: an epidemiological study. Stroke 14:342–347
Bonita R, Thomson S (1985) Subarachnoid hemorrhage: epidemiology, diagnosis, management and outcome. Stroke 16:591–594
Pakarinen S (1967) Incidence, aetiology and prognosis of primary subarachnoid hemorrhage: a study based on 589 cases diagnosed in a defined urban population during a defined period. Acta Neurol Scand 43(Suppl 29):1–128
Phillips LH II, Whisnant JP, O’ Fallon WM, Sundt TM Jr (1980) The unchanging pattern of subarachnoid hemorrhage in a community. Neurology 30:1034–1040
Sacco RL, Wolf PA, Bharucha NE, Meeks SL, Kannel WB, Charette LJ, Mcnamara PM, Palmer EP, D’Agostino R (1984) Subarachnoid and intracerebral hemorrhage: natural history, prognosis and percussive factors in the Framingham Study. Neurology 34:847–854
Fogelholm R (1981) Subarachnoid hemorrhage in middle Finland: incidence, early prognosis and indication in neurosurgical treatment. Stroke 12:296–301
Inagawa T (2001) Trends in incidence and case fatality rates of aneurysmal subarachnoid hermorrhage in Izumo city, Japan, between 1980–1989 and 1990–1998. Stroke 32:149–157
Kassell NF, Torner JC, Haley EC Jr, Jane JA, Adams HP, Kongable GL (1990) The International Cooperative study on the timing of aneurysm surgery Part 1: Overall management results. J Neurosurg 73:18–36
Lougheed W, Morley T, Tasker R, Marshall B, Wortzmann G, Harwood-Nash D (1965) The results of surgical treatment of ruptured berry aneurysms. In: Intracranial aneurysm and subarachnoid hemorrhage. Springfield III, CC Thomas 295–314
Shephard RH (1983) Ruptured cerebral aneurysms: early and late prognosis with surgical treatment. A personal series, 1950–1980. J Neurosurg 59:6–15
Fridriksson SM, Hillman J, Saveland H, Brandt L (1995) Intracranial aneurysm surgery in the 8th and 9th decades of life: impact on population-based management outcome. Neurosurgery 37(4):627–632
Takeuchi J (1993) Aneurysm surgery in patients over the age of 80 years. Br J Neurosurg 7:307–309
Hamada JI, Morioka M, Miura M, Fujioka S, Marubayshi T, Ushio Y (2001) Management outcome for ruptured anterior circulation aneurysms with a Hunt and Hess clinical grade of III in patients in the ninth decade of life. Surg Neurol 56:294–300
Hamada JI, Hasegawa S, Kai Y, Morioka M, Fujioka S, Ushio Y (1999) Surgery and long-term outcome for ruptured anterior circulation aneurysms in patients in their ninth decade of life. Surg Neurol 52:123–127
Yano S, Hamada JI, Todaka T, Hara T, Mizuno T, Morioka M, Ushio Y (2003) Surgical indications to maintain quality of life in elderly patients with ruptured intracranial aneurysms. Neurosurgery 52(5):1010–1016
Sakaki S, Ohta S, Ohue S, Kohno K, Matsuoka K (1989) Outcome in elderly patients with ruptured intracranial aneurysms. Clin Neurol Neurosurg 91(1):21–27
Pinsker MO, Gerstner W, Wolf S, Trost HA, Lumenta CB (2002) Surgery and outcome for aneurysmal subarachnoid hemorrhage in elderly patients. Acta Neurochir 82(Suppl):61–64
Laidlaw JD, Siu KH (2002) Aggressive surgical treatment of elderly patients following subarachnoid haemorrhage: management outcome results. J Clin Neurosci 9(4):404–410
Lan Q, Ikeda H, Jimbo H, Izumiyama H, Matsumoto K (2000) Considerations on surgical treatment for elderly patients with intracranial aneurysms. Surg Neurol 53(3):231–238
Moriyama E, Matsumoto Y, Meguro T, Kawada S, Mandai S, Gohda Y, Sakurai M (1995) Progress in the management of patients with aneurysmal subarachnoid hemorrhage: a single hospital review for 20 years. Part II: Aged patients. Surg Neurol 44(6):528–533
Noterman J, Dewitte O, Baleriaux D, Vandesteene A, Raftopoulos C, Brotchi J (1995) Subarachnoid hemorrhage in patients over 65 years of age. Retrospective study of 72 patients including 65 cases of aneurysmal origin. Neurochirurgie 41(1):51–57
Griva F, Tartara F, Longo A, Oliveri G, Boccaletti R (2002) Management of cerebral aneurysms in elderly patients. An analysis of the literature/La gestione degli aneurismi cerebrali nei pazienti anziani. Analisi della letteratura Rivista di Neuroradiologia 15:597–601
Birchall D, Khangure M, McAuliffe W, Apsimon H, Knuckey N (2001) Endovascular management of acute subarachnoid haemorrhage in the elderly. Br J Neurosurg 15(1):35–38
Sawada M, Kaku Y, Hayashi K, Ueda T, Yoshimura S, Sakai N (2000) Endovascular treatment of ruptured intracranial aneurysms using platinum coils in patients over 70 years of age. Interv Neuroradiol 6(Suppl 1):85–88
Sedat J, Dib M, Lonjon M, Litrico S, Von Langsdorf D, Fontaine D, Paquis P (2002) Endovascular treatment of ruptured intracranial aneurysms in patients aged 65 years and older: follow-up of 52 patients after 1 year. Stroke 33(11):2620–2625
Bracard S, Lebedinsky A, Anxionnat R, Neto JM, Audibert G, Long Y, Picard L (2002) Endovascular treatment of Hunt and Hess grade IV and V aneuryms. Am J Neuroradiol 23(6):953–957
Kremer C, Groden C, Hansen HC, Grzyska U, Zeumer H (1999) Outcome after endovascular treatment of Hunt and Hess grade IV or V aneurysms: comparison of anterior versus posterior circulation. Stroke 30(12):2617–2622
Le Roux PD, Elliott JP, Newell DW, Grady MS, Winn HR (1996) Predicting outcome in poor-grade patients with subarachnoid hemorrhage: a retrospective review of 159 aggressively managed cases. J Neurosurg 85(1):39–49
Zentner J, Hoffmann C, Schramm J (1996) Results of early surgery in poor-grade aneurysm patients. J Neurosurg Sci 40(3–4):183–188
Johnston SC, Higashida RT, Barrow DL, Caplan LR, Dion JE, Hademenos G, Hopkins LN, Molyneux A, Rosenwasser RH, Vinuela F, Wilson CB (2002) Recommendations for the endovascular treatment of intracranial aneurysms: a statement for healthcare professionals from the Committee on Cerebrovascular Imaging of the American Heart Association Council on Cardiovascular Radiology. Stroke 33(10):2536–2544
Acknowledgements
We are grateful to J.-N. Vallée for his help with statistical analysis.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00234-005-1345-0