Abstract
The purpose of this retrospective study was to evaluate the results of two treatment options, endovascular coil embolization and surgical neck clipping, for ruptured intracranial aneurysms in aged patients (over 70 years old) where the treatment began within 72 hours after the ictus. During the last 11 years, 46 patients were treated with coil embolization (n=27) or clipping (n=19) in our hospital. Ruptured dissecting aneurysms and giant aneurysms were excluded in this study. Coil embolization was preferably chosen when the patient was over 75 years old, with high neurological grade, and the aneurysm was located in the posterior circulation. Clinical outcomes were evaluated using the Glasgow Outcome Scale at discharge. In the coil embolization group, 11 of 14 (78.6%) patients with Hunt and Kosnik grade I-III showed good recovery (GR) or moderately disabled (MD). In the clipping group, 6 of 13 (46.2%) patients with grade I-III showed GR or MD. However, there was no favorable outcome in patients with grade IV in either group. After the treatment, incidences of vasospasm related cerebral infarction and shunt dependent hydrocephalus were not significantly different between the two groups. The incidence of pneumonia during the hospitalization was higher in grade III and IV patients compared with grade I and II patients. In conclusion, elderly patients over 70 years old suffering from intracranial ruptured aneurysm with a Hunt and Kosnik grade I-III can be treated successfully using coil embolization or clipping. However, treatment indication should be carefully determined in grade IV patients.
