A randomized controlled study assessing outcome,cognition, autonomy and quality of life in over 70-year-old patients after aneurysmal subarachnoid hemorrhage |
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| Authors: | F Proust S Bracard J-P Lejeune L Thines X Leclerc G Penchet J Bergé X Morandi J-Y Gauvrit K Mourier F Ricolfi M Lonjon J Sedat B Bataille J Droineau T Civit E Magro I Pelissou-Guyotat B Irthum |
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| Institution: | 1. Department of neurosurgery, Hautepierre hospital Strasbourg, university hospital, 67098 Strasbourg, France;2. Department of neurosurgery, Charles Nicolle hospital Rouen university hospital, 76000 Rouen, France;3. Neuroradiology department, Nancy university hospital, 29, avenue du Maréchal-De-Lattre-de-Tassigny, 54035 Nancy cedex, France;4. Neurosurgery department, Lille university hospital, Salengro hospital, avenue Prof-Emile Laine, 59037 Lille cedex, France;5. Neurosurgery department, Besançon university hospital, 3, boulevard Alexandre Fleming, 25030 Besançon cedex, France;6. Neuroradiology department, Lille university hospital, Salengro hospital, avenue Prof-Emile Laine, 59037 Lille cedex, France;7. Neurosurgery department, Bordeaux university hospital, Pellegrin hospital, place Amélie Raba-Léon, 33000 Bordeaux, France;8. Neuroradiology department, Bordeaux university hospital, Pellegrin hospital, place Amélie Raba-Léon, 33000 Bordeaux, France;9. Neurosurgery department, Rennes university hospital, Pontchaillou hospital, 2, rue Henry Leguillou, 35033 Rennes cedex 09, France;10. Neuroradiology department, Rennes university hospital, Pontchaillou hospital, 2, rue Henry Leguillou, 35033 Rennes cedex 09, France;11. Neurosurgery department, Dijon university hospital, F. Mitterand Hospital, 2, boulevard Maréchal-De-Lattre-de-Tassigny, 21033 Dijon cedex, France;12. Neuroradiology department, Dijon university hospital, F. Mitterand hospital, 2, boulevard Maréchal-De-Lattre-de-Tassigny, 21033 Dijon cedex, France;13. Neurosurgery department, Nice university hospital, Pasteur hospital, 30, avenue de la Voie Romaine, 06000 Nice, France;14. Neuroradiology department, Nice university hospital, Pasteur hospital, 30, avenue de la Voie Romaine, 06000 Nice, France;15. Neurosurgery department, Poitiers university hospital, 86000 Poitiers, France;p. Neuroradiology department, Poitiers university hospital, 86000 Poitiers, France;q. Neurosurgery department, Nancy university hospital, 29, avenue du Maréchal-De-Lattre-de-Tassigny, 54035 Nancy cedex, France;r. Neurosurgery department, Brest university hospital, Cavale Blanche hospital, boulevard Tanguy Prigent, 29200 Brest, France;s. Neurosurgery department, Lyon university hospital, 69677 Bron, France;t. Neurosurgery department, Strasbourg university hospital, Hautepierre hospital, avenue Molière, 67098 Strasbourg cedex, France;u. Neurosurgery department, Paris university hospital, Hôpital Bicêtre, 94275 Le Kremlin-Bicêtre, France;v. Neurosurgery department, Caen university hospital, 14033 Caen, France;w. Neuroradiology department, Caen university hospital, 14033 Caen, France;x. Neurosurgery department, Bordeaux university hospital, 33000 Bordeaux, France;y. Biostatistics department, Rouen university hospital, Charles Nicolle hospital, 76000 Rouen, France;z. Neurosurgery department, Marseille university hospital, hôpital Nord, 13000 Marseille, France;11. Grenoble university hospital, France;12. Neuroradiology department, Clermont-Ferrand university hospital, 63003 Clermont-Ferrand, France;13. Neurosurgery department, Clermont-Ferrand university hospital, 63003 Clermont-Ferrand, France |
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| Abstract: | BackgroundCurrent aging of the population with good physiological status and the increasing incidence of subarachnoid hemorrhage (SAH) in elderly patients has enhanced the benefit of treatment in terms of independence and long-term quality of life (QoL).MethodsFrom November 1, 2008 to October 30, 2012, 351 patients aged 70 years or older with aneurysmal SAH underwent adapted treatment: endovascular coiling (EV) for 228 (65%) patients, microsurgical clipping (MS) for 75 (29.3%) or conservative treatment for 48 (13.7%). Forty-one of these were randomized to EV (n = 20) or to MS (n = 21). The objectives were to determine the proportion of patients with modified Rankin Scale score ≤ 2 (independence) at 1 year, and, secondarily, to compare cognitive function on the Mini-Mental State Examination (MMSE), autonomy on the Activities of Daily Living Index (ADLI) and Instrumental Activities of Daily Living scale (IADL), and QoL, in the prospective and randomized arms, at 1 year.ResultsAt 1 year, with 1 loss to follow-up in the EV arm, 11 patients (55%) were independent after EV occlusion and 8 (38.1%) after MS exclusion, without significant difference (P = 0.29). Mortality was higher after MS during the first 2 postoperative months, and thereafter the difference between MS and EV ceased to be significant. Cognitive function and autonomy scores were similar in both arms.ConclusionIn elderly patients treated for aneurysmal SAH, approximately 50% were independent at 1 year, with conserved cognition and autonomy. EV and MS are valid procedures in this population, with similar results at 1 year in terms of independence, cognition, autonomy, and QoL. |
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| Keywords: | Intracranial aneurysm Subarachnoid hemorrhage Elderly Randomized controlled study |
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