2018 年 12 巻 6 号 p. 273-280
Objective: To explain the results of endovascular treatment for unruptured cerebral aneurysms in elderly patients, we divided patients with unruptured cerebral aneurysms who underwent endovascular treatment in our hospital into three groups: elderly (75 years and older), pre-elderly (65–74 years), and young (65 years and younger) groups, and compared the treatment results.
Subjects and Methods: In our hospital, 646 patients (elderly: 53, pre-elderly: 242, young: 351) with unruptured cerebral aneurysms underwent initial endovascular treatment between April 2007 and December 2015. We retrospectively compared aneurysmal factors, treatment methods, and treatment results (complications, results of embolization immediately after surgery, and results of follow-up imaging).
Results: The mean ages of the subjects in the aforementioned groups were 77.8 ± 2.45 (75–84 years), 69.2 ± 2.93 (65–74 years), and 53.3 ± 8.64 (26–64 years) years. Mean volume embolization ratios (VERs) of the elderly and pre-elderly groups were significantly lower when compared with that of the young group. Complete occlusion (Raymond Scale [RS] 1) was found in 48 (94.1%), 210 (87.5%), and 316 (91.6%) patients in the elderly, pre-elderly, and young groups, respectively, using digital subtraction angiography. Complications were noted in 8 (15.4%), 23 (9.5%), and 27 (7.7%) patients in the elderly, non-elderly, and young groups, respectively. In the elderly group, the incidence of embolic complications was slightly, although not remarkably, higher. On the final follow-up imaging, RS 1 was achieved in 40 (80.0%), 196 (83.1%), and 295 (86.5%) patients in the elderly, pre-elderly, and young groups, respectively; these differences did not rise to the level of statistical significance. Recanalization was achieved in 9 (18.0%), 31 (13.1%), and 39 (11.4%) patients in the elderly, pre-elderly, and young groups, respectively. Additional treatment was required for 1 (2.0%), 5 (2.1%), and 4 (1.2%) patients, in the elderly, pre-elderly, and young groups, respectively, showing no significant between-group differences.
Conclusion: The results of endovascular treatment for unruptured cerebral aneurysms in both the elderly and pre-elderly groups were similar to those in the young group. After due consideration of all known indications and treatment methods, endovascular treatment should be considered a feasible management for elderly patients.