Endovascular Coiling of Intracranial Aneurysms in Elderly Patients: Report of 205 Treated Aneurysms

被引:41
作者
Gonzalez, Nestor R. [1 ,2 ]
Dusick, Joshua R. [1 ]
Duckwiler, Gary [2 ]
Tateshima, Satoshi [2 ]
Jahan, Reza [2 ]
Martin, Neil A. [1 ]
Vinuela, Fernando [2 ]
机构
[1] Univ Calif Los Angeles, David Geffen Sch Med, Dept Neurosurg, Los Angeles, CA 90095 USA
[2] Univ Calif Los Angeles, David Geffen Sch Med, Dept Radiol, Los Angeles, CA 90095 USA
关键词
Aneurysm; Coiling; Elderly; Embolization; Endovascular; DETACHABLE COILS; TRIAL ISAT; CEREBRAL ANEURYSMS; EXPERIENCE; EMBOLIZATION; NEUROFORM; OCCLUSION;
D O I
10.1227/01.NEU.0000367451.59090.D7
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND: More elderly patients are presenting with intracranial aneurysms. Many are poor surgical candidates and often undergo endovascular treatment. OBJECTIVE: We present our experience with embolization in elderly patients. METHODS: We performed a retrospective review of a prospective database of elderly patients treated with coil embolization for intracranial aneurysms. RESULTS: In a period of 16 years, 205 aneurysms were treated in 196 individuals ( age range, 70-96 years; mean age, 77.3 years), including 159 females ( average follow-up, 16.2 months). Ninety-seven patients presented with unruptured aneurysms, and 99 patients presented after subarachnoid hemorrhage; the diagnosis was confirmed by computed tomographic scan or lumbar puncture. Complete occlusion was achieved in 53 aneurysms (26%), with a neck remnant in 127 (62%), incomplete occlusion in 13 (6%), and 12 unsuccessful attempts. Postembolization, 89.3% of patients were neurologically intact or unchanged, whereas 8.7% had new deficits. Four patients died. By modified Rankin Scale score, at last clinical evaluation, 128 patients (65%) had a good outcome. Follow-up angiograms were available for 113 aneurysms; they revealed that 62% were unchanged, 21% were further thrombosed, and 17% had recanalized. Three aneurysms ruptured after treatment during follow-up. Rupture was not associated with incomplete occlusion or neck remnant results (P = .6). Twenty-five aneurysms required reembolization. Reembolization was not associated with new deficits or death ( odds ratio, 0.56; 95% confidence interval, 0.19-1.58; P = .27). CONCLUSION: Coil embolization of intracranial aneurysms is safe and effective in the elderly. Preembolization clinical condition strongly correlates with clinical outcome. Incomplete embolizations are not associated with a higher rerupture risk. Additional embolization does not affect the clinical results.
引用
收藏
页码:714 / 721
页数:8
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