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Multicenter Study
. 2024 Mar 1;47(1):100.
doi: 10.1007/s10143-024-02325-z.

Endovascular coiling versus neurosurgical clipping in the management of aneurysmal subarachnoid haemorrhage in the elderly: a multicenter cohort study

Keng Siang Lee #  1   2   3 , Isabel Siow #  4 , Lily Wy Yang  5 , Aaron Sc Foo  6 , John Jy Zhang  6 , Ian Mathews  7 , Chun Peng Goh  6 , Colin Teo  6 , Bolem Nagarjun  6 , Vanessa Chen  6 , Sein Lwin  6 , Kejia Teo  6 , Shiong Wen Low  8 , Ira Sy Sun  8 , Boon Chuan Pang  9 , Eugene Wr Yang  9 , Cunli Yang  10 , Anil Gopinathan  10 , Tseng Tsai Yeo  6 , Vincent Dw Nga  6
Affiliations
Multicenter Study

Endovascular coiling versus neurosurgical clipping in the management of aneurysmal subarachnoid haemorrhage in the elderly: a multicenter cohort study

Keng Siang Lee et al. Neurosurg Rev. .

Abstract

The comparability of endovascular coiling over neurosurgical clipping has not been firmly established in elderly patients with aneurysmal subarachnoid haemorrhage (aSAH). Data were obtained from all patients with aSAH aged ≥60 across three tertiary hospitals in Singapore from 2014 to 2019. Outcome measures included modified Rankin Scale (mRS) score at 3 and at 6 months, and in-hospital mortality. Of the 134 patients analyzed, 84 (62.7%) underwent coiling and 50 (37.3%) underwent clipping. The endovascular group showed a higher incidence of good mRS score 0-2 at 3 months (OR = 2.45 [95%CI:1.16-5.20];p = 0.018), and a lower incidence of in-hospital mortality (OR = 0.31 [95%CI:0.10-0.91];p = 0.026). There were no significant difference between the two treatment groups in terms of good mRS score at 6 months (OR = 1.98 [95%CI:0.97-4.04];p = 0.060). There were no significant differences in the incidence of complications, such as aneurysm rebleed, delayed hydrocephalus, delayed ischemic neurological deficit and venous thromboembolism between the two treatment groups. However, fewer patients in the coiling group developed large infarcts requiring decompressive craniectomy (OR = 0.32 [95%CI:0.12-0.90];p = 0.025). Age, admission WFNS score I-III, and coiling were independent predictors of good functional outcomes at 3 months. Only age and admission WFNS score I-III remained significant predictors of good functional outcomes at 6 months. Endovascular coiling, compared with neurosurgical clipping, is associated with significantly better short term outcomes in carefully selected elderly patients with aSAH. Maximal intervention is recommended for aSAH in the young elderly age group and those with favorable WFNS scores.

Keywords: Aneurysm; Clipping; Cohort study; Elderly; Endovascular; Geriatric; Subarachnoid hemorrhage.

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Conflict of interest statement

The authors report no conflict of interest.

Figures

Fig. 1
Fig. 1
Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) flow chart demonstrating inclusion/exclusion of patients identified across the National University Health System (NUHS) cluster in Singapore from 2014 to 2019
Fig. 2
Fig. 2
Alluvial plot to visualize the journey amongst the elderly patients with aneurysmal subarachnoid hemorrhage with the three mRS categories – 0 to 2, 3 to 5 and 6 – at 3 months (N = 134). Journeys of the various mRS categories are represented by a “track” that flows through the stages of independent predictors of good functional outcomes. The columns indicate whether or not the patients had those predictors. The thickness of the track corresponds to the number of respondents who shared the same mRS categories. mRS = modified Rankin scale. WFNS = World Federation of Neurosurgical Societies
See this image and copyright information in PMC

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