Abstract
Objective: When a growing unruptured intracranial aneurysm (UIA) is detected by serial magnetic resonance angiography (MRA) in elderly patients aged 80 years or older, it is difficult to decide the treatment strategy of the UIAs in the elderly (80 years or older) because aneurysm growth correlates with higher risk of rupture in spite of their potentially shorter life expectancy and hazards related to treatment. We present, here, 4 cases of growing asymptomatic UIA in the elderly (80 years or older) in whom endovascular treatment was performed successfully and had good midterm outcomes.
Method: Four consecutive patients who underwent endovascular treatment between April 2009 and March 2013 were retrospectively evaluated.
Result: All the four patients were women and their mean age at the time of endovascular treatment was 81.8 years (range, 81–83 years). All were healthy and were able to carry out their activities of daily life. But they presented with growing UIAs, including middle cerebral artery aneurysms (n=3) and a posterior communicating artery aneurysm (n=1). The size of the aneurysms on admission was mean 5.0 mm (range, 3.3–6.5 mm). The aneurysms had increased in maximum diameter by mean 2.0 times (range, 1.6–3.0 times) during observation (range 24–64 months) and grown to the size of mean 9.4 mm (range 7.1–11.7 mm). All patients underwent coil embolization (2 patients using stent assisted technique) successfully without any procedure-related complication. Complete obliteration was achieved in one aneurysm, with a small neck remnant in three aneurysms. At discharge, all patients had modified Rankin Scale (mRS) score 0. During follow-up interval (range 6–47 months), all patients maintained mRS 0 without any treatment-related complication. All patients underwent follow-up imaging by angiography or MRA. The mean imaging follow-up period was 16.8 months (range, 6–43 months) and no interval change of the degree of aneurysm occlusions was demonstrated.
Conclusion: We suggest that endovascular treatment for growing UIAs of patients aged 80 years or older appears to be safe and effective if we can keep very low procedural risks.
