Endovascular treatment of ruptured intracranial aneurysms in elderly patients: clinical features and treatment outcome

Abstract

Management of ruptured intracranial aneurysm in elderly patients is still a major challenge in the treatment of cerebrovascular disease. This study aimed to evaluate safety and efficacy profiles of ruptured intracranial aneurysms in elderly patients treated with endovascular techniques (EVTs). We conducted a retrospective case review of 53 consecutive elderly patients with ruptured intracranial aneurysms treated by EVT between the year 2011 and 2016. The patients' angiographic outcomes, clinical outcomes, and procedure-related complications were reviewed retrospectively. Univariate and multivariate logistic analysis were applied to determine the risk factors of aneurysm recurrence and clinical prognosis. In 29 (54.7%) patients, the treatment was attempted with coiling alone. The vascular remodeled technique was applied in 24 (45.3%) patients. At a median angiographic follow-up of 9 months, 35 (67.3%) aneurysms showed stable, 9 (17.3%) were improvement, and 8 (15.4%) were recurrent. According to the multivariate analysis, the size of the aneurysm was independently associated with increased risk of aneurysm recurrence (odds ratio, 1.92; 95% confidence interval, 1.181-2.211; p = 0.006). High Hunt-Hess grade at admission was an independent predictor of poor functional outcome in the multivariate analysis (odds ratio, 5.93; 95% confidence interval, 1.878-33.63; p = 0.008). In 8 (15.1%) patients, it resulted in procedure-related complications. EVT of ruptured intracranial aneurysms in elderly patients is safe, effective, and have low recurrent rate. Recurrence after EVT for ruptured aneurysms is common in cases of large-size aneurysms. The overall clinical outcome was worst in patients presented with high Hunt-Hess grade.

Keywords: Elderly; Endovascular techniques; Recurrence; Ruptured intracranial aneurysms.