Aneurysmal Subarachnoid Hemorrhage in the Elderly over Age 75: A Systematic Review

Abstract

The number of elderly patients with an aneurysmal subarachnoid hemorrhage (aSAH) has been increasing in aging- or aged societies in many countries. A treatment strategy for the elderly with aSAH has not been established, although many studies have been published emphasizing poor outcome for aSAH. The aim of this study was to analyze the factors and treatments affecting outcome in aSAH in the elderly in a systematic review of the literature by investigating patients over age 75. A literature search was done for “elderly aSAH” in PubMed and Embase. Literature with a clear description of treatment measures for aneurysmal occlusion and outcome was selected. Twelve studies, consisted of 816 cases, met the eligibility criteria. Patient characteristics included 83.2% female, 33.8% poor clinical grade on admission, 57.1% Fischer group 3, and 41% internal carotid artery aneurysm. As complications, symptomatic vasospasm was seen in 25.5% of patients, hydrocephalus in 31.1%, and medical complication in 38.4%. Favorable outcome was 35.0% in total, 45.3% for clipping, 36.3% for coiling, and 9.0% for conservative treatment. Several studies by multivariate analysis indicated that poor clinical grade on admission could be a risk factor for neurological outcome and mortality. Advanced age and selection of conservative treatment without aneurysmal occlusion could be a risk factor for mortality. Patients under age 85 with good clinical grade on admission can be candidates for treatment of aneurysm repair. However, treatment for patients over age 85 or with poor clinical grade should be carefully determined.

Clinical Outcome of Endovascular Coil Embolization For Cerebral Aneurysms In Asian Population In Relation To Risk Factors: A 3-Year Retrospective Analysis

“…Past studies showed that Europeans women over the age of 60 have excellent to good outcomes however our study showed the inverse to be true (10). Asian women are seen to have the poorest recovery and high morbidity rate when compared to various age groups and comorbidities.…”

“…Similarly, age also plays a role in thromboembolic events with patients above the age of 50 having higher likelihood of rupture (10). Similarly, age groups of patients when younger than 30 or older than 50 have an equal likelihood of poor recovery but patients between the ages of 30-50 have the best recovery rates.…”

A scoring model to predict the prognosis of patients with poor-grade aneurysmal subarachnoid hemorrhage

“…The choice of treatment methods is signi cantly related to the prognosis of patients with poor-grade aSAH. In a systematic review of 815 patients with aSAH, researchers reported that the good prognosis of clipping, embolization and conservative treatment were 45.3%, 36.3% and 9.0%, respectively [20]. In our study, the adverse prognosis of patients treated with clipping or coiling were signi cantly lower than those treated with conservative therapy and there was no statistically signi cant difference in prognosis between clipping and embolization.…”

Outcomes of Endovascular Therapy versus Microsurgical Treatment for Aneurysmal Subarachnoid Hemorrhage in Patients ≥70 Years of Age

“…In some past reports of treatment outcomes of elderly aSAH patients, good outcomes were attained in 36.4%-65.0% of the MST group and 33.3%-78.7% of the EVT group. [1][2][3][4][8][9][10][11][12][15][16][17][18][19] In this study, we achieved good outcomes in 19.3% of the MST group and 22.9% of the EVT group, with each of these outcomes poorer than in past reports. Because our hospital is an emergency and critical care center, the proportion of elderly patients with severe aSAH (Hunt and Kosnik grade IV-V) was very high (IV: 19.5% and V: 47.5% in the EVT group, IV: 25.3% and V: 25.3% in the MST group).…”

“…1) Several studies have reported that elderly patients with aSAH who have undergone microsurgical treatment (MST) have a poor prognosis. [2][3][4] Hence, endovascular therapy (EVT) for elderly patients with aSAH has been suggested because it is less invasive than MST. Other reports, however, found that outcomes with EVT for aSAH in elderly patients are similar to those achieved with MST, rendering the effectiveness of EVT versus MST for aSAH unclear.…”