2018 Volume 3 Issue 2 Pages 47-52
Objective: The incidence of procedures for subarachnoid hemorrhage (SAH) in elderly people has increased recently as life expectancy has increased. We investigated clinical outcomes of SAH treatment with a coil-first strategy at our institution.
Methods: A total of 33 patients aged 80 or older who were treated for SAH between April 2010 and June 2017 were retrospectively reviewed (30 females, mean age 84.6 [80–93]) and divided according to the treatment method into a coil embolization group and a clipping group. Background and clinical outcome were compared between two groups, and cases that were difficult to treat were considered.
Results: The coil embolization group included 22 cases (66.7%), and the clipping group included 11 cases (33.3%). A good outcome, as defined by a Modified Rankin Scale score of 0-2 at discharge or 3-month follow-up, was more common in the coil embolization group (6/22; 27.3%) than in the clipping group (2/11; 18.2%), although there was no significant difference. Four of 11 cases in the clipping group (36.4%), however, had concurrent hematoma, which significantly affected outcome. In addition, some cases were difficult to treat because of advanced age.
Conclusion: The clinical outcome of coil-first SAH treatment involved few complications in elderly people, although a lower proportion of cases resulted in good outcome than in young people. Clipping, however, is necessary in some cases that are unsuitable for coil embolization. Tailored treatment and periprocedural general management might be also necessary due to multiple risks associated with advanced age.
