We report our experience in the endovascular treatment with detachable platinum coils of ruptured or symptomatic unruptured cerebral aneurysms in 61 patients aged 70-82 years. Complete occlusion was achieved in 38, subtotal in 17 and partial in one. The treatment failed in five patients. Clinical follow-up was performed in all patients for 8 months to 8 years. No bleeding occurred during the follow-up period. Outcome was favourable in 63% of the patients. When we compared the outcome of elderly patients with those of younger age endovascularly treated in the same period of time, we found a significantly higher frequency of poorer outcome in the elderly group (chi(2) = 9.084; P = 0.011). The frequency of favourable outcome in the elderly was significantly lower than in the younger group for H-H IV-V (chi(2) = 9.299; P = 0.010). The most important factor influencing the outcome was not age itself, but primary clinical condition on admission. The therapy of symptomatic aneurysms in elderly patients should not be purely conservative--a direct approach of the aneurysm should be considered. Endovascular treatment whenever possible seems to be a good alternative to surgery.

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The aim of this study is to consider the results of the aneurysms treated in our unit in the last years. The results of a given treatment are very difficult to evaluate if a series of prior assumptions have not been made, i.e., the goals of treatment, patient selection, and so on. This is particularly true if alternative treatments are available and if, as in the present work, the cases are recruited over a relatively long time with respect to the time of evolution of the technique.Two techniques were used, occlusion of the parent vessel with secondary thrombosis of the aneurysm and selective occlusion of the aneurysm with coils.Il trattamento endovascolare degli aneurismi Parte seconda: i risultati RIASSUNTO -L'obiettivo di questo lavoro è quello di analizzare i risultati del trattamento degli aneurismi nel nostro Istituto durante lo scorso anno.I risultati di un determinato trattamento sono molto difficili da valutare in carenza di alcune premesse, quali ad esempio gli obiettivi del trattamento, la selezione dei pazienti, ecc. Ciò è vero in particolare se sono possibili trattamenti alternativi e se, come in questo lavoro, i casi sono raccolti in un tempo relativamente lungo in proporzione all'evoluzione della tecnica.Vengono usate due tecniche diverse: l'occlusione del vaso afferente, con trombosi secondaria dell'aneurisma e l'occlusione selettiva della sacca con spirali.