Endovascular Treatment of Intracranial Aneurysms in Elderly Patients

Abstract

We assessed the following variables and outcomes: aneurysm rupture status, aneurysm adjunctive treatment technique (balloon-assisted Background and Purpose-Use of endovascular coiling for treatment of ruptured and unruptured intracranial aneurysms (IAs) in the elderly is increasing. We performed a meta-analysis of the literature examining clinical and angiographic outcomes for treatment of IAs in the elderly. Methods-We performed a comprehensive review of the literature from 1995 to 2012, reporting series of patients ≥65 years of age with ruptured or unruptured IAs treated with endovascular approach. Event rates were pooled across studies using random effects meta-analysis. Results-A total of 21 studies reporting on 1511 patients were included. Long-term aneurysm occlusion rates were 79% (95% confidence interval [CI], 70%-85%). Perioperative stroke occurred in 4% (95% CI, 3%-6%), with similar rates between patients with ruptured (5%; 95% CI, 3%-7%) and unruptured aneurysms (4%; 95% CI, 1%-14%; P=0.68).Intraprocedural rupture occurred in 1% (95% CI, 0%-3%) and 4% (95% CI, 2-6%; P=0.04) of patients with unruptured and ruptured aneurysms, respectively. Perioperative mortality rate for patients with ruptured aneurysms was 23% (95% CI, 17%-30%) and 1% (95% CI, 0%-6%) for patients with unruptured aneurysms (P<0.01). Rates of good clinical outcome at 1 year were 93% (95% CI, 88%-96%) and 66% (95% CI, 59%-72%) in patients with unruptured and ruptured aneurysms, respectively. Conclusions-This study suggests that endovascular treatment of IAs in the elderly is associated with high long-term occlusion rates. Given the morbidity and mortality associated with endovascular treatment of IAs in the elderly, careful patient selection, especially in the case of patients with unruptured aneurysm, is recommended. (Stroke. 2013;44:1897-1902.)

Age-related outcomes following intracranial aneurysm treatment with the Pipeline Embolization Device: a subgroup analysis of the IntrePED registry

“…9 One meta-analysis of endovascular treatment of intracranial aneurysms in 1511 elderly patients (≥ 65 years old) found that the rate of good neurological outcome without significant disability following unruptured aneurysm coil embolization was 82% at 6-12 months and 91% at 12 months or longer. 11 The rates of combined disability and mortality during long-term follow-up after coil embolization of unruptured aneurysms was between 7% and 15%, similar to our finding of 13%.…”

“…4,11,13 Flow diversion is a more recently developed endovascular technique, and several single-center and multicenter series have reported encouraging early results, especially in the treatment of complex proximal internal carotid artery (ICA) aneurysms.1-3 However, given the relatively small size of these series, the effect of age on periprocedural complication rates and long-term clinical outcomes after flow diversion is difficult to establish. The International Retrospective Study of the Pipeline Embolization Device (IntrePED) is a large multicenter study conducted to assess the incidence of periprocedural complications after Pipeline (Medtronic) embolization of intracranial aneurysms in a "real world" scenario.…”

“…4,11,13 Flow diversion is a more recently developed endovascular technique, and several single-center and multicenter series have reported encouraging early results, especially in the treatment of complex proximal internal carotid artery (ICA) aneurysms.…”

Blood Flow Into Basilar Tip Aneurysms

“…2,3 Endovascular coil embolization is occasionally preferred in the management of unruptured intracranial aneurysms because it is less invasive than surgical clipping. [5][6][7][8] However, the longterm risk and durability of coil embolization are unknown. 9,10 The frequencies of aneurysm rests or recurrences are higher after coil embolization than that after surgical clipping.…”

Endovascular treatment of ruptured intracranial aneurysms: Indications, techniques and results

“…A meta-analysis published in 2013 [11] showed high morbidity and mortality (9% and 23% respectively), although this was related more to the severity of the subarachnoid hemorrhage and its complications than to complications of endovascular treatment itself with a 4% aneurysm rupture rate and 5% postoperative ischemic injuries. At 1 year, 66% of patients had recovered well or had only moderate handicap, allowing them to be independent in their activities of daily living.…”