Endovascular treatment of intracranial aneurysms in patients 65 years or older: clinical outcomes

BACKGROUND AND PURPOSE: A controversial discussion concerning treatment of aneurysms in elderly patients exists. The aim of this study was to analyze clinical outcome in patients older than 65 years harboring intracranial aneurysms after endovascular treatment.MATERIALS AND METHODS: A total of 108 patients aged 65 years or older (mean age, 72 years, range, 65–87 years) were selected for endovascular treatment between 1997 and 2005. A total of 85 (78.7%) patients had an acute subarachnoid hemorrhage (SAH). SAH was classified according to Hunt and Hess (HH) grade: I (n = 16), II (n = 11), III (n = 33), IV (n = 19), and V (n = 6). There were 69 aneurysms that were small; 46, medium; 8, large; and 5, giant. Occlusion rate was categorized as complete (100%), subtotal (95% to 99%), and incomplete (<95%) obliteration according to the Raymond scale.RESULTS: Endovascular treatment was technically feasible in 108 of 113 aneurysms. Complete occlusion could be achieved in 80 patients; basal remnant was seen in 26 patients and a dog ear in 2 patients. Procedural complications included thrombotic vessel occlusion (n = 9), aneurysmal rupture (n = 4), and stenosis of the parent vessel (n = 2). The Glasgow Outcome Scale (GOS) for the patients with SAH after 6 months was good recovery (n = 43), moderate disability (n = 12), severe disability (n = 28), persistent vegetative state (n = 5), and death (n = 18). Outcome for the patients with unruptured aneurysms was good recovery in all 23 patients. On follow-up digital subtraction angiography (DSA) in 69 patients, complete aneurysmal occlusion was confirmed in 81% after 6 months. Five patients with recanalization were re-treated with coiling.CONCLUSION: Endovascular treatment of ruptured and unruptured intracranial aneurysms in this subgroup was safe and effective.

The incidence of subarachnoid hemorrhage (SAH) increases with age: at the third decade of life, the incidence is approximately 1.5 to 2.5 per 100,000 per year, at the eighth decade, it is approximately 40 to 78 per 100,000 per year.^1,2 Conservative treatment of ruptured aneurysms in elderly patients is known to be associated with a poor outcome.³ Some studies reveal a slightly better outcome after surgery,⁴ but these results are not consistent.⁵There are some findings that the outcome in elderly patients is not associated by age but by the clinical grade of the aneurysm.⁶ First, results concerning endovascular treatment revealed a benefit in outcome for this patient group.⁷ However, because of a higher incidence of atherosclerotic diseases and tortuous vessels, the procedural complications in respect to thromboembolic events and therapy failure may increase. Furthermore, the individual life expectancy and the risk for aneurysmal rupture have to be estimated before a decision is made about therapy.⁸ Some studies on the use of endovascular therapies in elderly patients did reveal a higher risk for this subgroup of patients (eg, the SPACE study reported a higher risk for patients older than 70 years).⁹ Therefore, the question arises of whether endovascular therapy should be performed according to an age-related category.