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Multicenter Study
. 2025 Mar 15;65(3):148-154.
doi: 10.2176/jns-nmc.2024-0212. Epub 2025 Feb 5.

Outcome after Endovascular Treatment of Patients with Ruptured Cerebral Aneurysm over 90 Years of Age

Fuminori Shimizu  1   2 , Kazutaka Uchida  3 , Jiro Takeuchi  2 , Hiroto Kakita  1 , Sou Sawamura  1 , Akihiro Kanbara  1 , Yuji Kitada  1 , Yoshinori Akiyama  1 , Takashi Yoshida  1 , Kiyoshi Asada  2 , Satoru Fujiwara  4 , Hirotoshi Imamura  5 , Chiaki Sakai  6 , Manabu Shirakawa  3 , Shinichi Yoshimura  3 , Nobuyuki Sakai  1 , Masato Kasahara  2 ; JR-NET4 Study Group
Affiliations
Multicenter Study

Outcome after Endovascular Treatment of Patients with Ruptured Cerebral Aneurysm over 90 Years of Age

Fuminori Shimizu et al. Neurol Med Chir (Tokyo). .

Abstract

For ruptured cerebral aneurysms over 90 years of age, the outcome and the safety after endovascular treatment are not well-known. This multicenter retrospective registry enrolled patients with ruptured cerebral aneurysms after endovascular treatment from January 2015 to December 2019 in Japan. We investigated differences between the patients over 90 years (age ≥ 90) and those under 90 years of age (age <90). The primary outcome was defined as a modified Rankin scale 0-2 at 30 days. Secondary outcomes were all-cause death and returned to premorbid modified Rankin scale at 30 days. Safety outcomes were the incidence of ischemic stroke and technical complications. Among 8,024 patients with aneurysm, 204 were aged ≥ 90 years and 7,820 were <90 years, those of median age were 92 and 65 years. The proportion of females and premorbid modified Rankin scale was higher in the age ≥ 90 group (n [%]; 191 [93.6] vs. 5,395 [69.0], median [interquartile range]; 1 [0-2] vs. 0 [0-0]). The modified Rankin scale 0-2 at 30 days was lower in age ≥ 90 patients than in age <90 patients (13.2% vs. 56.2%, adjusted odds ratio [95% confidence intervals]; 0.13 [0.08-0.21]). In age ≥ 90 patients, all-cause death was significantly higher (adjusted odds ratio [95% confidence intervals]; 1.85 [1.19-2.86]) and returned to premorbid modified Rankin scale was significantly lower (adjusted odds ratio [95% confidence intervals]; 0.26 [0.17-0.39]). However, safety outcomes were not significantly different between both groups. In this population undergoing endovascular treatment for ruptured cerebral aneurysms, patients older than 90 years had a poor prognosis but no difference in having perioperative complications.

Keywords: functional outcome; ischemic stroke; ruptured cerebral aneurysm; technical complication; very older patient.

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Conflict of interest statement

All authors who are members and nonmembers of the Japan Neurosurgical Society (JNS) have registered self-reported COI disclosure statements through the JNS website. All other authors have no conflict of interest.

Figures

Fig. 1
Fig. 1
Study flowchart. JR-NET4: Japanese Registry of NeuroEndovascular Therapy 4
Fig. 2
Fig. 2
Distribution of modified Rankin scale at 30 days after the procedure p <0.0001.
See this image and copyright information in PMC

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