Risk of rupture of unruptured cerebral aneurysms in elderly patients

Hishikawa, Tomohito; Date, Isao; Tokunaga, Koji; Tominari, Shinjiro; Nozaki, Kazuhiko; Shiokawa, Yoshiaki; Houkin, Kiyohiro; Murayama, Yuichi; Ishibashi, Toshiyuki; Takao, Hiroyuki; Kimura, Toshikazu; Nakayama, Takeo; Morita, Akio; Investigators, Ucas Ii

doi:10.1212/wnl.0000000000002149

Cited by 50 publications

(26 citation statements)

References 12 publications

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“…Kim et al believed that a sidewall aneurysm found with multiple aneurysms or an AcomA aneurysm found from a patient with hypertension may be prone to rupture at smaller sizes. In a prospective study in Japan (29), patient age and PcomA were reported to be significant risk factors for rupture in the elderly patients. Similarly, our results show that small ruptured cerebral aneurysms at the location of the PcomA are more common and the proportion of multiple aneurysms is higher in the elderly patients compared with those in the nonelderly patients.…”

Section: Discussionmentioning

confidence: 96%

Influence of Age-Related Complications on Clinical Outcome in Patients With Small Ruptured Cerebral Aneurysms

2020

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Background: Small ruptured cerebral aneurysms (≤5 mm) account for the majority of aneurysmal subarachnoid hemorrhages, and its clinical management remains a challenge. The aim of this study was to identify the effect of age-related complications on the outcome of patients with small ruptured aneurysm. Methods: A retrospective review was performed in patients with small ruptured aneurysms who underwent microsurgical clipping or endovascular coiling from September 2012 to December 2018. According to their ages, the patients were divided into the elderly group and the non-elderly group. Baseline characteristics, clinical complications, and outcome of patients were analyzed between the two groups. A multivariate logistic regression analysis was used to determine the risk factors associated with the poor outcome of the elderly patients. Results: In the elderly group, 83 patients were treated with clipping and 50 were treated with coiling. In the non-elderly group, 188 patients were treated with clipping and 117 were treated with coiling. The incidence of neurological complications with neurologic deficit in the elderly group was significantly higher compared with that in the non-elderly group (P = 0.006). The elderly patients had a longer hospital stay (P = 0.032) and a poorer outcome (P = 0.001) compared with the non-elderly patients. A multivariate analysis showed that irregular aneurysms (P = 0.045) and ischemic events (P < 0.001) were independent risk factors associated with poor outcome in the elderly. Conclusions: Neurological complications with neurologic deficit, especially ischemic complications, were clearly more common in the elderly patients. Irregular small aneurysms or postoperative ischemic events should be paid attention as the higher risk of poor outcome in the elderly.

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Section: Discussionmentioning

confidence: 96%

Influence of Age-Related Complications on Clinical Outcome in Patients With Small Ruptured Cerebral Aneurysms

2020

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“…Furthermore, only 89.3% of the elderly patients with UA were in good preoperative condition with mRS 0–2, and the remaining patients with poor preoperative condition should not be treated. Taking into consideration that the rupture risk of unruptured aneurysm in the elderly patients is about 3.6%, 24) indication of NET for UA in the elderly patients should be decided strictly.…”

Section: Discussionmentioning

confidence: 99%

Safety and Feasibility of Neuroendovascular Therapy for Elderly Patients: Analysis of Japanese Registry of Neuroendovascular Therapy 3

Arimura

Iihara

Satow

et al. 2019

Neurol. Med. Chir.(Tokyo)

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Japan has a rapidly aging population and the application of neuroendovascular therapy (NET) for cerebrovascular diseases among elderly patients has increased, but feasibility and safety of NET for elderly patients are still debated. Therefore, this study aimed to elucidate feasibility and safety of NET by analyzing the Japanese nationwide database, the Japanese Registry of Neuroendovascular Therapy 3 (JR-NET 3). In total, 35,972 patients in the JR-NET 3 were analyzed retrospectively. “Elderly patients” were defined as those aged ≥75 years. Approximately one-quarter of patients who received NET were elderly patients. The proportion of patients with modified Rankin Scale (mRS) 0–2 before treatment and 30 days after NET was significantly low across all diseases in the elderly patients. Technical success rates were generally high across all procedures, but complication rate was significantly higher among elderly patients; ischemic complications were significantly higher with NET for unruptured aneurysms (UA) and carotid artery stenosis (CAS). Multivariate analysis revealed that mRS 0–2 before treatment [odds ratio (OR): 0.56, 95% confidence interval (CI): 0.34–0.94, P = 0.03], middle cerebral artery aneurysm (OR: 0.33, 95% CI: 0.12–0.92, P = 0.04), and complete obliteration (OR: 0.66, 95% CI: 0.44–0.97, P = 0.03) were associated with ischemic complications with NET for UA. Moreover, mRS 0–2 before treatment (OR: 0.55, 95% CI: 0.36–0.86, P < 0.01), high intensity with time-of-flight magnetic resonance angiography (OR: 1.55, 95% CI: 1.03–2.32, P = 0.04), open-cell stent (OR: 2.20, 95% CI: 1.50–3.22, P <0.01) were associated with ischemic complications with NET for CAS. Taken together, our findings indicate that cautious and precise selection of patients suitable for NET is necessary.

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“…20) Higher age is a significant risk factor for UCA rupture in elderly patients. 49) The Japanese population includes a very high proportion of elderly individuals and Japan has the highest life expectancy at birth worldwide, according to health data from the OECD. 50) Therefore, many elderly patients aged over 65 years old receive treatment for UCAs in Japan.…”

Section: Treatment For Ucamentioning

confidence: 99%

Characteristics of Cerebral Aneurysms in Japan

Ikawa

Hidaka

Yoshiyama

et al. 2019

Neurol. Med. Chir.(Tokyo)

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The characteristics of cerebral aneurysms in Japan differ from other countries in the higher incidence of unruptured cerebral aneurysm detected by brain check-up screening, higher rupture rate of unruptured cerebral aneurysm, higher incidence of subarachnoid hemorrhage, and superior outcome after subarachnoid hemorrhage based on meta-analysis. Head shape, genetic features, environmental factors, demographics, and medical system in Japan are also different from other countries. Unruptured cerebral aneurysms are 2.8 times more likely to rupture in Japanese than western aneurysms, resulting in the highest incidence of subarachnoid hemorrhage in the world. The exact and specific mechanisms of de novo, growth, and rupture of cerebral aneurysms have not been elucidated. Investigations will contribute to the understanding of cerebral aneurysms and subarachnoid hemorrhage worldwide. Some features of cerebral aneurysm in Japan are discussed for possible research guidance in the elucidation of the predominance of subarachnoid hemorrhage in Japan.

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Risk of rupture of unruptured cerebral aneurysms in elderly patients

Cited by 50 publications

References 12 publications

Influence of Age-Related Complications on Clinical Outcome in Patients With Small Ruptured Cerebral Aneurysms

Influence of Age-Related Complications on Clinical Outcome in Patients With Small Ruptured Cerebral Aneurysms

Safety and Feasibility of Neuroendovascular Therapy for Elderly Patients: Analysis of Japanese Registry of Neuroendovascular Therapy 3

Characteristics of Cerebral Aneurysms in Japan

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