One-stage coiling versus clipping of multiple intracranial aneurysms in elderly patients

Objectives: Although multiple intracranial aneurysms (MIAs) are frequent and disastrous, determining treatment strategy for them is often complicated, especially in elderly patients (>= 60 years old). We evaluated the safety and effectiveness of one-stage coiling versus surgical clipping for MIAs in elderly patients. Methods: All elderly patients who underwent one-stage embolization or surgical clipping for more than two aneurysms were identified in our hospital between January 2012 and June 2018. Patient characteristics and clinical outcomes at discharge and follow-up were retrospectively evaluated. Results: A total of 32 patients with 76 IAs underwent one-stage coiling and 21 patients with 46 IAs underwent one-stage clipping were enrolled in this study. Patients who underwent clipping were younger (mean age 64.1 versus 67.2, P = 0.006) and had lower total hospital costs (mean14764 $ versus 24,620 $, P < 0.001) compared with patients who underwent coiling. Immediate posttreatment angiography showed complete occlusion in 56 aneurysms, near complete in 11 and incomplete in 2 in coiling group. Aneurysms wrapping was performed in 2, incomplete clipping in 1 and complete clipping in 41 aneurysms in clipping group. At discharge, 49 (92.5 %) patients were in a good condition (GOS score 4 and 5), 4 (7.5 %) were disabled. At 12 months after discharge, 25 (92.6 %) and 16 (94.1 %) patients had favorable outcomes in the coiling and clipping groups, respectively. Conclusions: Both one-stage coiling and surgical clipping are safe, effective methods for treating MIAs in elderly patients.