Results of Endovascular Treatment in 295 Elderly Patients with Unruptured Cerebral Aneurysms in Comparison with Non-elderly Patients in a Single Institution
Objective: To explain the results of endovascular treatment for unruptured cerebral aneurysms in elderly patients, we divided patients with unruptured cerebral aneurysms who underwent endovascular treatment in our hospital into three groups: elderly (75 years and older), pre-elderly (65–74 years), a...
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| Published in | Journal of Neuroendovascular Therapy Vol. 12; no. 6; pp. 273 - 280 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
The Japanese Society for Neuroendovascular Therapy
2018
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1882-4072 2186-2494 |
| DOI | 10.5797/jnet.oa.2017-0084 |
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| Abstract | Objective: To explain the results of endovascular treatment for unruptured cerebral aneurysms in elderly patients, we divided patients with unruptured cerebral aneurysms who underwent endovascular treatment in our hospital into three groups: elderly (75 years and older), pre-elderly (65–74 years), and young (65 years and younger) groups, and compared the treatment results.Subjects and Methods: In our hospital, 646 patients (elderly: 53, pre-elderly: 242, young: 351) with unruptured cerebral aneurysms underwent initial endovascular treatment between April 2007 and December 2015. We retrospectively compared aneurysmal factors, treatment methods, and treatment results (complications, results of embolization immediately after surgery, and results of follow-up imaging).Results: The mean ages of the subjects in the aforementioned groups were 77.8 ± 2.45 (75–84 years), 69.2 ± 2.93 (65–74 years), and 53.3 ± 8.64 (26–64 years) years. Mean volume embolization ratios (VERs) of the elderly and pre-elderly groups were significantly lower when compared with that of the young group. Complete occlusion (Raymond Scale [RS] 1) was found in 48 (94.1%), 210 (87.5%), and 316 (91.6%) patients in the elderly, pre-elderly, and young groups, respectively, using digital subtraction angiography. Complications were noted in 8 (15.4%), 23 (9.5%), and 27 (7.7%) patients in the elderly, non-elderly, and young groups, respectively. In the elderly group, the incidence of embolic complications was slightly, although not remarkably, higher. On the final follow-up imaging, RS 1 was achieved in 40 (80.0%), 196 (83.1%), and 295 (86.5%) patients in the elderly, pre-elderly, and young groups, respectively; these differences did not rise to the level of statistical significance. Recanalization was achieved in 9 (18.0%), 31 (13.1%), and 39 (11.4%) patients in the elderly, pre-elderly, and young groups, respectively. Additional treatment was required for 1 (2.0%), 5 (2.1%), and 4 (1.2%) patients, in the elderly, pre-elderly, and young groups, respectively, showing no significant between-group differences.Conclusion: The results of endovascular treatment for unruptured cerebral aneurysms in both the elderly and pre-elderly groups were similar to those in the young group. After due consideration of all known indications and treatment methods, endovascular treatment should be considered a feasible management for elderly patients. |
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| AbstractList | Objective: To explain the results of endovascular treatment for unruptured cerebral aneurysms in elderly patients, we divided patients with unruptured cerebral aneurysms who underwent endovascular treatment in our hospital into three groups: elderly (75 years and older), pre-elderly (65–74 years), and young (65 years and younger) groups, and compared the treatment results.Subjects and Methods: In our hospital, 646 patients (elderly: 53, pre-elderly: 242, young: 351) with unruptured cerebral aneurysms underwent initial endovascular treatment between April 2007 and December 2015. We retrospectively compared aneurysmal factors, treatment methods, and treatment results (complications, results of embolization immediately after surgery, and results of follow-up imaging).Results: The mean ages of the subjects in the aforementioned groups were 77.8 ± 2.45 (75–84 years), 69.2 ± 2.93 (65–74 years), and 53.3 ± 8.64 (26–64 years) years. Mean volume embolization ratios (VERs) of the elderly and pre-elderly groups were significantly lower when compared with that of the young group. Complete occlusion (Raymond Scale [RS] 1) was found in 48 (94.1%), 210 (87.5%), and 316 (91.6%) patients in the elderly, pre-elderly, and young groups, respectively, using digital subtraction angiography. Complications were noted in 8 (15.4%), 23 (9.5%), and 27 (7.7%) patients in the elderly, non-elderly, and young groups, respectively. In the elderly group, the incidence of embolic complications was slightly, although not remarkably, higher. On the final follow-up imaging, RS 1 was achieved in 40 (80.0%), 196 (83.1%), and 295 (86.5%) patients in the elderly, pre-elderly, and young groups, respectively; these differences did not rise to the level of statistical significance. Recanalization was achieved in 9 (18.0%), 31 (13.1%), and 39 (11.4%) patients in the elderly, pre-elderly, and young groups, respectively. Additional treatment was required for 1 (2.0%), 5 (2.1%), and 4 (1.2%) patients, in the elderly, pre-elderly, and young groups, respectively, showing no significant between-group differences.Conclusion: The results of endovascular treatment for unruptured cerebral aneurysms in both the elderly and pre-elderly groups were similar to those in the young group. After due consideration of all known indications and treatment methods, endovascular treatment should be considered a feasible management for elderly patients. |
| Author | Neki, Hiroaki Otsuka, Toshihiro Yamane, Fumitaka Kohyama, Shinya Ishihara, Hideaki Yonezawa, Azusa Ishihara, Shoichiro |
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| References | 5) Greving JP, Wermer MJ, Brown RD, et al: Development of the PHASES score for prediction of risk of rupture of intracranial aneurysms: a pooled analysis of six prospective cohort studies. Lancet Neurol 2014; 13: 59–66. 16) Ohta T, Nakahara I, Matsumoto S, et al: [Treatment and outcomes of the patients over the age of 80 with ruptured aneurysmal subarachnoid hemorrhage]. Surg Cereb Stroke 2014; 42: 132–135. (in Japanese 15) van der Schaaf IC, Brilstra EH, Rinkel GJ, et al: Quality of life, anxiety, and depression in patients with an untreated intracranial aneurysm or arteriovenous malformation. Stroke 2002; 33: 440–443. 13) King JT, Kassam AB, Yonas H, et al: Mental health, anxiety, and depression in patients with cerebral aneurysms. J Neurosurg 2005; 103: 636–641. 8) Mahaney KB, Brown RD, Meissner I, et al: Age-related differences in unruptured intracranial aneurysms: 1-year outcomes. J Neurosurg 2014; 121: 1024–1038. 17) Tada Y, Satomi J, Yagi K, et al: [Treatment outcomes in patients older than 80 years presenting with ruptured intracranial aneurysms]. Surg Cereb Stroke 2014; 42: 42–46. (in Japanese 6) Juvela S, Porras M, Poussa K: Natural history of unruptured intracranial aneurysms: probability of and risk factors for aneurysm rupture. J Neurosurg 2000; 93: 379–387. 22) Grunwald IQ, Papanagiotou P, Politi M, et al: Endovascular treatment of unruptured intracranial aneurysms: occurrence of thromboembolic events. Neurosurgery 2006; 58: 612–618; discussion 612–618. 4) Khosla A, Brinjikji W, Cloft H, et al: [Age-related complications following endovascular treatment of unruptured intracranial aneurysms]. AJNR Am J Neuroradiol 2012; 33: 953–957. 21) Ishida W, Sato M, Amano T, et al: The significant impact of framing coils on long-term outcomes in endovascular coiling for intracranial aneurysms: how to select an appropriate framing coil. J Neurosurg 2016; 125: 705–712. 11) International Study of Unruptured Intracranial Aneurysms Investigators: Unruptured intracranial aneurysms–risk of rupture and risks of surgical intervention. N Engl J Med 1998; 339: 1725–1733. 18) Boyd CM, Landefeld CS, Counsell SR, et al: Recovery of activities of daily living in older adults after hospitalization for acute medical illness. J Am Geriatr Soc 2008; 56: 2171–2179. 24) Kang DH, Hwang YH, Kim YS, et al: Cognitive outcome and clinically silent thromboembolic events after coiling of asymptomatic unruptured intracranial aneurysms. Neurosurgery 2013; 72: 638–645; discussion 645. 23) Hwang G, Jung C, Park SQ, et al: Thromboembolic complications of elective coil embolization of unruptured aneurysms: the effect of oral antiplatelet preparation on periprocedural thromboembolic complication. Neurosurgery 2010; 67: 743–748; discussion 748. 10) Oishi H, Yamamoto M, Nonaka S, et al: Treatment results of endosaccular coil embolization of asymptomatic unruptured intracranial aneurysms in elderly patients. J Neurointerv Surg 2015; 7: 660–665. 19) Brown CJ, Roth DL, Allman RM, et al: Trajectories of life-space mobility after hospitalization. Ann Intern Med 2009; 150: 372–378. 2) Lanzino G, Kassell NF, Germanson TP, et al: Age and outcome after aneurysmal subarachnoid hemorrhage: why do older patients fare worse? J Neurosurg 1996; 85: 410–418. 9) Qureshi AI, Chaudhry SA, Tekle WG, et al: Comparison of long-term outcomes associated with endovascular treatment vs surgical treatment among Medicare beneficiaries with unruptured intracranial aneurysms. Neurosurgery 2014; 75: 380–386; discussion 386–387. 3) Manaka H, Sakai N, Nagata I, et al: [Treatment Results and Surgical Complications of Asymptomatic Non-ruptured Intracranial Aneurysms]. Surg Cereb Stroke 2001; 29: 414–419. (in Japanese 14) Kubo Y, Koji T, Kashimura H, et al: Female sex as a risk factor for the growth of asymptomatic unruptured cerebral saccular aneurysms in elderly patients. J Neurosurg 2014; 121: 599–604. 20) Gill TM, Allore HG, Gahbauer EA, et al: Change in disability after hospitalization or restricted activity in older persons. JAMA 2010; 304: 1919–1928. 26) Horiuchi T, Tanaka Y, Hongo K: Surgical treatment for aneurysmal subarachnoid hemorrhage in the 8th and 9th decades of life. Neurosurgery 2005; 56: 469–475; discussion 469–475. 12) Meng H, Tutino VM, Xiang J, et al: High WSS or low WSS? Complex interactions of hemodynamics with intracranial aneurysm initiation, growth, and rupture: toward a unifying hypothesis. AJNR Am J Neuroradiol 2014; 35: 1254–1262. 7) UCAS Japan Investigators, Morita A, Kirino T, et al: The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med 2012; 366: 2474–2482. 1) Inagawa T, Yamamoto M, Kamiya K, et al: Management of elderly patients with aneurysmal subarachnoid hemorrhage. J Neurosurg 1988; 69: 332–339. 25) Britz GW, Salem L, Newell DW, et al: Impact of surgical clipping on survival in unruptured and ruptured cerebral aneurysms: a population-based study. Stroke 2004; 35: 1399–1403. 22 23 24 25 26 10 11 12 13 14 15 16 17 18 19 1 2 3 4 5 6 7 8 9 20 21 |
| References_xml | – reference: 21) Ishida W, Sato M, Amano T, et al: The significant impact of framing coils on long-term outcomes in endovascular coiling for intracranial aneurysms: how to select an appropriate framing coil. J Neurosurg 2016; 125: 705–712. – reference: 25) Britz GW, Salem L, Newell DW, et al: Impact of surgical clipping on survival in unruptured and ruptured cerebral aneurysms: a population-based study. Stroke 2004; 35: 1399–1403. – reference: 12) Meng H, Tutino VM, Xiang J, et al: High WSS or low WSS? Complex interactions of hemodynamics with intracranial aneurysm initiation, growth, and rupture: toward a unifying hypothesis. AJNR Am J Neuroradiol 2014; 35: 1254–1262. – reference: 17) Tada Y, Satomi J, Yagi K, et al: [Treatment outcomes in patients older than 80 years presenting with ruptured intracranial aneurysms]. Surg Cereb Stroke 2014; 42: 42–46. (in Japanese) – reference: 8) Mahaney KB, Brown RD, Meissner I, et al: Age-related differences in unruptured intracranial aneurysms: 1-year outcomes. J Neurosurg 2014; 121: 1024–1038. – reference: 9) Qureshi AI, Chaudhry SA, Tekle WG, et al: Comparison of long-term outcomes associated with endovascular treatment vs surgical treatment among Medicare beneficiaries with unruptured intracranial aneurysms. Neurosurgery 2014; 75: 380–386; discussion 386–387. – reference: 18) Boyd CM, Landefeld CS, Counsell SR, et al: Recovery of activities of daily living in older adults after hospitalization for acute medical illness. J Am Geriatr Soc 2008; 56: 2171–2179. – reference: 2) Lanzino G, Kassell NF, Germanson TP, et al: Age and outcome after aneurysmal subarachnoid hemorrhage: why do older patients fare worse? J Neurosurg 1996; 85: 410–418. – reference: 10) Oishi H, Yamamoto M, Nonaka S, et al: Treatment results of endosaccular coil embolization of asymptomatic unruptured intracranial aneurysms in elderly patients. J Neurointerv Surg 2015; 7: 660–665. – reference: 7) UCAS Japan Investigators, Morita A, Kirino T, et al: The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med 2012; 366: 2474–2482. – reference: 22) Grunwald IQ, Papanagiotou P, Politi M, et al: Endovascular treatment of unruptured intracranial aneurysms: occurrence of thromboembolic events. Neurosurgery 2006; 58: 612–618; discussion 612–618. – reference: 24) Kang DH, Hwang YH, Kim YS, et al: Cognitive outcome and clinically silent thromboembolic events after coiling of asymptomatic unruptured intracranial aneurysms. Neurosurgery 2013; 72: 638–645; discussion 645. – reference: 14) Kubo Y, Koji T, Kashimura H, et al: Female sex as a risk factor for the growth of asymptomatic unruptured cerebral saccular aneurysms in elderly patients. J Neurosurg 2014; 121: 599–604. – reference: 6) Juvela S, Porras M, Poussa K: Natural history of unruptured intracranial aneurysms: probability of and risk factors for aneurysm rupture. J Neurosurg 2000; 93: 379–387. – reference: 19) Brown CJ, Roth DL, Allman RM, et al: Trajectories of life-space mobility after hospitalization. Ann Intern Med 2009; 150: 372–378. – reference: 3) Manaka H, Sakai N, Nagata I, et al: [Treatment Results and Surgical Complications of Asymptomatic Non-ruptured Intracranial Aneurysms]. Surg Cereb Stroke 2001; 29: 414–419. (in Japanese) – reference: 11) International Study of Unruptured Intracranial Aneurysms Investigators: Unruptured intracranial aneurysms–risk of rupture and risks of surgical intervention. N Engl J Med 1998; 339: 1725–1733. – reference: 23) Hwang G, Jung C, Park SQ, et al: Thromboembolic complications of elective coil embolization of unruptured aneurysms: the effect of oral antiplatelet preparation on periprocedural thromboembolic complication. Neurosurgery 2010; 67: 743–748; discussion 748. – reference: 1) Inagawa T, Yamamoto M, Kamiya K, et al: Management of elderly patients with aneurysmal subarachnoid hemorrhage. J Neurosurg 1988; 69: 332–339. – reference: 5) Greving JP, Wermer MJ, Brown RD, et al: Development of the PHASES score for prediction of risk of rupture of intracranial aneurysms: a pooled analysis of six prospective cohort studies. Lancet Neurol 2014; 13: 59–66. – reference: 26) Horiuchi T, Tanaka Y, Hongo K: Surgical treatment for aneurysmal subarachnoid hemorrhage in the 8th and 9th decades of life. Neurosurgery 2005; 56: 469–475; discussion 469–475. – reference: 16) Ohta T, Nakahara I, Matsumoto S, et al: [Treatment and outcomes of the patients over the age of 80 with ruptured aneurysmal subarachnoid hemorrhage]. Surg Cereb Stroke 2014; 42: 132–135. (in Japanese) – reference: 4) Khosla A, Brinjikji W, Cloft H, et al: [Age-related complications following endovascular treatment of unruptured intracranial aneurysms]. AJNR Am J Neuroradiol 2012; 33: 953–957. – reference: 15) van der Schaaf IC, Brilstra EH, Rinkel GJ, et al: Quality of life, anxiety, and depression in patients with an untreated intracranial aneurysm or arteriovenous malformation. Stroke 2002; 33: 440–443. – reference: 13) King JT, Kassam AB, Yonas H, et al: Mental health, anxiety, and depression in patients with cerebral aneurysms. J Neurosurg 2005; 103: 636–641. – reference: 20) Gill TM, Allore HG, Gahbauer EA, et al: Change in disability after hospitalization or restricted activity in older persons. JAMA 2010; 304: 1919–1928. – ident: 5 doi: 10.1016/S1474-4422(13)70263-1 – ident: 19 doi: 10.7326/0003-4819-150-6-200903170-00005 – ident: 6 doi: 10.3171/jns.2000.93.3.0379 – ident: 2 doi: 10.3171/jns.1996.85.3.0410 – ident: 16 doi: 10.2335/scs.42.132 – ident: 20 doi: 10.1001/jama.2010.1568 – ident: 9 doi: 10.1227/NEU.0000000000000450 – ident: 24 doi: 10.1227/NEU.0b013e3182846f74 – ident: 12 doi: 10.3174/ajnr.A3558 – ident: 8 doi: 10.3171/2014.6.JNS121179 – ident: 17 doi: 10.2335/scs.42.42 – ident: 4 doi: 10.3174/ajnr.A2881 – ident: 14 doi: 10.3171/2014.5.JNS132048 – ident: 13 doi: 10.3171/jns.2005.103.4.0636 – ident: 7 doi: 10.1056/NEJMoa1113260 – ident: 11 doi: 10.1056/NEJM199812103392401 – ident: 26 doi: 10.1227/01.NEU.0000153926.67713.B8 – ident: 21 doi: 10.3171/2015.7.JNS15238 – ident: 10 doi: 10.1136/neurintsurg-2014-011305 – ident: 1 doi: 10.3171/jns.1988.69.3.0332 – ident: 23 doi: 10.1227/01.NEU.0000374770.09140.FB – ident: 22 doi: 10.1227/01.NEU.0000204101.00996.D9 – ident: 15 doi: 10.1161/hs0202.102335 – ident: 18 doi: 10.1111/j.1532-5415.2008.02023.x – ident: 3 doi: 10.2335/scs.29.414 – ident: 25 doi: 10.1161/01.STR.0000128706.41021.01 |
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| Title | Results of Endovascular Treatment in 295 Elderly Patients with Unruptured Cerebral Aneurysms in Comparison with Non-elderly Patients in a Single Institution |
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