Interdisciplinary treatment of ruptured cerebral aneurysms in elderly patients

Abstract

Object The aim of the study was to assess postprocedural neurological deterioration and outcome in patients older than 70 years of age in whom treatment was managed in an interdisciplinary context. Methods This prospective longitudinal study included all patients 70 years of age or older treated for ruptured cerebral aneurysm over 10 years (June 1997–June 2007). The population was composed of 64 patients. The neurovascular interdisciplinary team jointly discussed the early obliteration procedure for each aneurysm. Neurological deterioration during the postprocedural 2 months and outcome at 6 months were assessed during consultation according to the modified Rankin Scale (mRS) as follows: favorable (mRS score ≤ 2) and unfavorable (mRS score > 2). Results Aneurysm sac obliteration was performed by microvascular clipping in 34 patients (53.1%) and by endovascular coiling in 30 (46.9%). Postprocedural neurological deterioration occurred in 30 patients (46.9%), related to ischemia in 19 (29.7%), rebleeding in 1 (1.6%), and hydrocephalus in 10 (15.6%). At 6 months, the outcome was favorable in 39 patients (60.9%). By multivariate regression logistic analysis, the independent factors associated with unfavorable outcome were age exceeding 75 years (p = 0.005), poor initial grade (p < 0.0001), and the occurrence of ischemia (p < 0.0001). Conclusions The baseline characteristics of SAH in the elderly were only slightly different from those in younger patients. In the elderly, the interdisciplinary approach may be considered useful to decrease the ischemic consequences.

Natural course of subarachnoid hemorrhage is worse in elderly patients

“…Aging probably is one of the most significant independent factors. It impairs several physiologic patterns related to cerebrovascular hemodynamics and homeostasis 6,7,8,9,10,11,12 . There is a decline in cerebral blood flow velocity with age, which may be associated with certain changes as: decreased cerebral blood flow (CBF) or metabolic demands; vessel changes like progressive kinking, calcifications (Figure 4), elongation, stenosis and lower cardiac output 1,2,3,11,13,14,15 .…”

“…All those statements justify that elderly usually present with more severe SAH than younger patients, characterized by higher Fisher and Hunt Hess grades. After treatment, elderly are also prone to face severe neurological and systemic complications, like vasospasm, hydrocephalus, brain and heart ischemic insults and others 6,7,8,9,10 . Cerebral vasospasm (VSP) is the major complication associated with aneurysmal SAH that results in delayed ischemic deficits in up to 25% of all cases.…”

Endovascular Treatment of Intracranial Aneurysms in Elderly Patients

“…Three studies exclusively included patients with unruptured aneurysms (281 cases), [19][20][21] whereas 18 studies included mainly patients with ruptured IAs (1080 of 1230 patients; 87.8%). [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] A total of 1511 patients were included in this study, and 1080 (71.5%) patients presented with SAH.…”

“…Several studies have examined the risks associated with endovascular treatment of ruptured [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] and unruptured [19][20][21] IAs in elderly patients, but large series are relatively lacking. To understand safety and efficacy profiles associated with the endovascular treatment of IAs in patients ≥65 years of age, we performed a meta-analysis of the literature.…”

Age-Related Trends in the Treatment and Outcomes of Ruptured Cerebral Aneurysms: A Study of the Nationwide Inpatient Sample 2001–2009

“…[9][10][11][12][13][14][15] Although the potential benefits of a less invasive treatment in elderly patients with aneurysmal SAH may seem intuitive, 16 some series have shown that the risks of endovascular coil embolization in this age group are not negligible, 17 and 1 singlecenter study demonstrated that the introduction of coil embolization of ruptured aneurysms was not associated with improved outcomes in elderly patients. 16 However, these studies were limited by the relatively small number of patients available for analysis.…”