Outcomes in a Case Series of Elderly Patients with Aneurysmal Subarachnoid Hemorrhages in the Barrow Ruptured Aneurysm Trial (BRAT)

Catapano, Joshua S; Louie, Christopher E; Lang, Michael J; DiDomenico, Joseph D.; Whiting, Alexander C; Labib, Mohamed A.; Cole, Tyler S; Fredrickson, Vance L; Cavalcanti, Daniel D; Lawton, Michael T.

doi:10.1016/j.wneu.2020.04.007

Cited by 13 publications

(2 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Even elderly patients with good neurological grades may have worse outcomes compared to younger patients. Catapano et al analysed outcomes of elderly patients with aneurysmal subarachnoid haemorrhage stratified by age and clinical presentation [ 41 ]. They reported that those 65 years and older were more likely to have poor functional outcomes compared to patients 60–65 years, and among good grade patients, those 65 years and older had poorer outcomes than the 60–65 years cohort at 6-year follow-up.…”

Section: Key Challenges In Elderly Patientsmentioning

confidence: 99%

Unruptured cerebral aneurysms in elderly patients: key challenges and management

et al. 2021

View full text Add to dashboard Cite

Unruptured cerebral aneurysms are increasingly identified in elderly patients as the global life expectancy continues to rise and non-invasive vascular imaging becomes more prevalent. The optimal management of unruptured aneurysms in elderly patients remains controversial. Variability in life expectancy, comorbidities and rupture risk coupled with heterogenous endovascular and surgical treatments contribute to a paucity of clear guidelines, and current management is highly individualized. Elderly patients present unique considerations including frailty, cognitive dysfunction, vasculopathy, reduced life expectancy and overall worse prognosis in case of rupture which shape the risks and likelihood of success of endovascular and microsurgical treatment. In this review, we provide a comprehensive overview of unruptured cerebral aneurysms in the elderly, with a particular focus on the natural history, key challenges associated with advanced age, management and future innovations to further refine treatment. Key Messages The management of unruptured cerebral aneurysms in elderly patients remains controversial. Key challenges including frailty, cognitive dysfunction, reduced life expectancy, vasculopathy and poor prognosis with aneurysm rupture add complexity to endovascular and surgical decision making not encountered with younger demographics. A thorough understanding of available treatment options, likelihood of treatment success and associated risks weighed against the risk of aneurysm rupture informs patient discussion and management.

show abstract

Section: Key Challenges In Elderly Patientsmentioning

confidence: 99%

Unruptured cerebral aneurysms in elderly patients: key challenges and management

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Because of this, the observed treatment benefit is purely risk-based. We applied a superior method to investigating heterogeneity of treatment effect than conventional subgroup analysis [ 2 , 3 , 25 , 26 ]. First, because the tool’s risk-based benefit estimation is not hampered by the power issue of conventional subgroup analysis.…”

Section: Discussionmentioning

confidence: 99%

Personalized decision-making for aneurysm treatment of aneurysmal subarachnoid hemorrhage: development and validation of a clinical prediction tool

de Winkel,

Roozenbeek,

Dijkland

et al. 2024

BMC Neurol

View full text Add to dashboard Cite

Background In patients with aneurysmal subarachnoid hemorrhage suitable for endovascular coiling and neurosurgical clip-reconstruction, the aneurysm treatment decision-making process could be improved by considering heterogeneity of treatment effect and durability of treatment. We aimed to develop and validate a tool to predict individualized treatment benefit of endovascular coiling compared to neurosurgical clip-reconstruction. Methods We used randomized data (International Subarachnoid Aneurysm Trial, n = 2143) to develop models to predict 2-month functional outcome and to predict time-to-rebleed-or-retreatment. We modeled for heterogeneity of treatment effect by adding interaction terms of treatment with prespecified predictors and with baseline risk of the outcome. We predicted outcome with both treatments and calculated absolute treatment benefit. We described the patient characteristics of patients with ≥ 5% point difference in the predicted probability of favorable functional outcome (modified Rankin Score 0–2) and of no rebleed or retreatment within 10 years. Model performance was expressed with the c-statistic and calibration plots. We performed bootstrapping and leave-one-cluster-out cross-validation and pooled cluster-specific c-statistics with random effects meta-analysis. Results The pooled c-statistics were 0.72 (95% CI: 0.69–0.75) for the prediction of 2-month favorable functional outcome and 0.67 (95% CI: 0.63–0.71) for prediction of no rebleed or retreatment within 10 years. We found no significant interaction between predictors and treatment. The average predicted benefit in favorable functional outcome was 6% (95% CI: 3–10%) in favor of coiling, but 11% (95% CI: 9–13%) for no rebleed or retreatment in favor of clip-reconstruction. 134 patients (6%), young and in favorable clinical condition, had negligible functional outcome benefit of coiling but had a ≥ 5% point benefit of clip-reconstruction in terms of durability of treatment. Conclusions We show that young patients in favorable clinical condition and without extensive vasospasm have a negligible benefit in functional outcome of endovascular coiling – compared to neurosurgical clip-reconstruction – while at the same time having a substantially lower probability of retreatment or rebleeding from neurosurgical clip-reconstruction – compared to endovascular coiling. The SHARP prediction tool (https://sharpmodels.shinyapps.io/sharpmodels/) could support and incentivize a multidisciplinary discussion about aneurysm treatment decision-making by providing individualized treatment benefit estimates.

show abstract

Treatment of octogenarians and nonagenarians with aneurysmal subarachnoid hemorrhage: a 17-year institutional analysis

et al. 2021

View full text Add to dashboard Cite

Outcomes in a Case Series of Elderly Patients with Aneurysmal Subarachnoid Hemorrhages in the Barrow Ruptured Aneurysm Trial (BRAT)

Cited by 13 publications

References 10 publications

Unruptured cerebral aneurysms in elderly patients: key challenges and management

Unruptured cerebral aneurysms in elderly patients: key challenges and management

Personalized decision-making for aneurysm treatment of aneurysmal subarachnoid hemorrhage: development and validation of a clinical prediction tool

Treatment of octogenarians and nonagenarians with aneurysmal subarachnoid hemorrhage: a 17-year institutional analysis

Contact Info

Product

Resources

About