| Endovascular Treatment of Ruptured Intracranial Aneurysms
in Elderly Patients Over 75 Years Old |
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Jae Il Lee1 , Sang Weon Lee1 , Tae Hong Lee2 , Jun Kyeung Ko1, Dong Wuk Son1 , Seung Heon Cha1 , Chang Hwa Choi1 |
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Department of 1Neurosurgery, 2Radiology, School of Medicine, Pusan National University, Busan, Korea |
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| Abstract |
Objective
The number of elderly patients with ruptured intracranial aneurysm has increased markedly as steep
increase in the population of the old age. Aggressive management of ruptured intracranial aneurysms in elderly patients
remain difficult because of inherent operative or procedural risks and patient comorbidities. We investigated the patient
clinical characteristics and the outcome of endovascular coil embolization treatment in elderly patients, aged over
75 years, with ruptured intracranial aneurysms.
Method: This study included 20 patients older than 75 years with ruptured intracranial aneurysms treated by
endovascular embolization between January 2000 and December 2007. We analyzed aneurysmal location, size, level
of consciousness, Hunt-Hess Grade on admission, Fisher's CT Grade, general medical and surgical condition,
vasospasm, hydrocephalus, and clinical outcome (GOS).
Results
There were 18 women and 2 men with a mean age of 78.8 years. The aneurysmal size was below 7 mm
in 14 patients, between 7～12 mm in five patients and one was 20 mm. Aneurysms in 19 patients were located in the
anterior circulation, and one was in the posterior circulation (basilar top). Five patients had wide-necked aneurysms
and then underwent stent-assisted, balloon-assisted, and two-catheter assisted coil embolization. Endovascular
embolization was technically successful in all patients. Hunt-Hess grades I, II were found in 4 patients, III in 6 patients
and grade IV,V were in 10 patients. Vasospasm was noted in 7 patients of which 4 cases were confirmed by radiological
diagnosis. Clinical outcomes (Glasgow Outcome Scale) at discharge were favorable in 8 (20%) patients and
unfavorable in 12 (80%) patients. Five patients were expired. The main causes of unfavorable outcome among elderly
patients were attributed to their poor Hunt-Hess grades on admission and post embolization medical com- plications.
There was no periprocedural complication related death.
Conclusion
Old age with ruptured intracranial aneurysm should not be considered contraindicated since recent
improvement in endovascular techniques and treatment outcomes. Early treatment of the ruptured intracranial aneurysm
can provide improved overall outcomes by reducing the incidence and extent of complications such as rebleeding
and vasospasm. However, comorbid cardiovascular diseases in elderly patients may increase risks of endovascular
treatment complication such as cerebral infarction. Therefore, physician should treat elderly patients with
extreme care when considering the coil embolization. |
| Key Words:
Aneurysm⋅Embolization⋅Elderly |
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