Abstract
We assessed clinical outcomes in elderly patients with ruptured intracranial aneurysms treated with selective embolization. Fourteen patients older than 70 years underwent endovascular treatment with Guglielmi detachable coils (GDC). Clinical outcomes were assessed using the Glasgow Outcome Scale (GOS). Preoperative Hunt and Kosnik grading revealed that 3 patients were in Grade II, 6 in Grade III, and 5 in Grade IV. The aneurysms were located in the internal carotid artery in 10 patients, in the anterior communicating artery in 2, and in the middle cerebral artery in 2, respectively.
Outcome was favorable in 65% of patients (GR or MD). One patient (7%) died 1 month after initial bleeding, and the mortality rate was 28.5% after 1 year. Among patients younger than 75 years old, all with Grade II or III had a GR, and 1 patient with Grade IV had a MD at the time of discharge. However, among patients older than 75 years, 1 with Grade III and all with Grade IV had died at the time of final follow-up. No procedural complications were present. Ischemic changes on CT due to vasospasm occurred more frequently in elderly patients (14.3%) than in younger patients (7.1%).
Endovascular treatment using GDC may be successful for selected elderly patients with ruptured intracranial aneurysms. However, among patients older than 75 years with Grade IV conditions, embolization did not result in useful life outcomes, and the mortality rate remains quite high.
