Abstract
The aim of this study was to analyze technical results and clinical outcomes in octogenarian patients with ruptured intracranial aneurysms treated with clipping or coil embolization. We reviewed the clinical records of 33 patients who underwent clipping or coil embolization for ruptured intracranial aneurysms between February 2003 and September 2012. Among them, 31 patients were female. The aneurysms were located in the anterior circulation in 29 (internal carotid artery: 9, anterior cerebral artery: 12, middle cerebral artery: 8), and in the posterior circulation in 4 (basilar artery: 2, vertebral artery: 2). WFNS grading at initial presentation were as follows: Grade 1: 9; Grade 2: 8; Grade 3: 2; Grade 4: 8; Grade 5: 6.
Twenty-two patients underwent clipping, and 11 patients underwent coil embolization. Twenty-four patients were treated within 72 hours from onset. Clinical outcomes were assessed at three months with the Glasgow Outcome Scale (GOS). Favorable outcome was defined as good recovery or moderately disabled. Technical success was achieved in 32 patients (97%). Procedure-related complications occurred in seven patients (21%), three of which resulted in clinical deterioration. GOS at three months were as follows: good recovery: 5; moderately disabled: 8; severely disabled: 15; vegetative survival: 2. Three deaths occurred, one was procedure-related and two were due to medical complications. Favorable outcomes were significantly associated with lower WFNS grading (WFNS Grade 1) at initial presentation (p＝0.009).
Aggressive treatment of ruptured intracranial aneurysms in octogenarian patients appears to be feasible in patients with mild subarachnoid hemorrhage. Careful patient selection with an interdisciplinary approach may be important to achieve a favorable outcome.
