高齢者未破裂脳動脈瘤に対する血管内治療の安全性と特殊性 ─Flow diverterの有用性を踏まえて─

抄録

Treatment of unruptured aneurysms in elderly patients tends to be contraindicated based on the risks and benefits for a limited life expectancy. In such cases, endovascular treatment has been frequently adopted because of its minimal invasiveness. We compared the results of endovascular treatment between non-elderly and elderly patients aged >75 years, and discussed its safety and agerelated issues.
We treated 531 patients with unruptured aneurysms in the past 5 years, including 74 elderly patients. We retrospectively examined and compared patient and aneurysm profiles, treatment methods, and angiographic and clinical results among non-elderly and elderly patients. We focused on large cavernous carotid aneurysms treated with flow diverters, which were used predominantly in the elderly.
The proportion of women was significantly greater in the elderly group. Aneurysms with a symptomatic mass effect, those of large and giant size, and those located in the cavernous portion were significantly greater in the elderly group. Regarding treatment methods, adjunctive techniques using double catheters and flow diversion were more often performed in the elderly group, and the rate of using the balloon or stent assist technique was higher in the non-elderly group. However, no significant differences in angiographic and clinical results were found between the two groups. However, the total complication rate was lower in the elderly group, and the rate of procedure-related ischemic complications was 4% in both groups, respectively. Among the 20 large carotid cavernous aneurysms, no significant differences in the rate of clinical improvement and angiographic results were found.
The clinical results and safety profiles of endovascular treatment for unruptured aneurysms in the elderly patients were not inferior to those in the non-elderly patients. In addition, considering the tendency for elderly patients to develop large aneurysms, particularly symptomatic large carotid aneurysms in the cavernous portion, the endovascular approach, including the use of a flow diverter, will be useful as a less invasive treatment option.