Endovascular treatment of ruptured intracranial aneurysms in patients aged 65 years and older - Follow-up of 52 patients after 1 year

Background and Purpose-We sought to describe the clinical outcome and results obtained in the endovascular therapy of ruptured cerebral aneurysms in the elderly over an 8-year period. We compared endovascular therapy results in patients aged greater than or equal to65 and <65 years. Methods-During 1993-1999, 52 patients aged 65 to 85 years (mean age, 71.5+/-4.7 years) were embolized with the use of Guglielmi detachable coils (group 1). During the same period, 143 patients aged <65 years (mean age, 47+/-14 years) with ruptured cerebral aneurysm were treated with the same technique (group 11). A clinical assessment was made on admission with the Hunt and Hess (HH) classification and again in the 12th month with the Glasgow Outcome Scale (GOS), with arteriographic control in months 3 and 12. Results-In group 1, clinical grades on admission were as follows: HH 1, 9.5%; HH 2, 33%; HH 3, 21%; HH 4, 34.5%; HH 5, 2%. Outcome was favorable in 48% of patients (GOS I or 2); the mortality rate was 23%. No rebleeding was observed. Patients presenting lesions greater than or equal to10 mm had an unfavorable outcome in >77% of cases. Thromboembolic complications were present in 13% of cases. In group 11, clinical grades on admission were as follows: HH 1, 14.5%; HH 2, 47%; HH 3, 11%; HH 4, 24%; HH 5, 3.5%. Favorable outcome (GOS I or 2) was observed in 77% of cases, with 14% mortality. Complications due to the endovascular procedure were present in 4.2% of cases. Patients with HH grades I or 2 on admission showed a positive outcome (GOS 1 or 2) in 77% of cases in group I and in 88.5% of cases in group H. Mortality was 9% in the first subgroup compared with 2.8% in the second. Patients who had a high clinical grade on admission.(HH 4 or 5) showed a favorable outcome (GOS I or 2) in 16% of cases in group I compared with 41% in group II. Conclusions-Endovascular treatment of ruptured intracranial aneurysms in patients aged greater than or equal to65 years appears to be effective against rebleeding and represents an alternative to surgery. However, perioperative thromboembolic complications are more frequent in the elderly population.