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

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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.

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References

  1. Bechan RS, Sprengers ME, Majoie CB, Peluso JP, Sluzewski M, van Rooij WJ (2016) Stent-assisted coil embolization of intracranial aneurysms: complications in acutely ruptured versus unruptured aneurysms. AJNR Am J Neuroradiol 37:502–507. https://doi.org/10.3174/ajnr.A4542

    Article  CAS  PubMed  Google Scholar 

  2. Braun V, Rath S, Antoniadis G, Richter HP, Borm W (2005) Treatment and outcome of aneurysmal subarachnoid haemorrhage in the elderly patient. Neuroradiology 47:215–221. https://doi.org/10.1007/s00234-005-1356-x

    Article  PubMed  Google Scholar 

  3. Brawanski N, Kunze F, Bruder M, Tritt S, Senft C, Berkefeld J, Seifert V, Konczalla J (2017) Subarachnoid hemorrhage in advanced age: comparison of patients aged 70-79 years and 80 years and older. World Neurosurgery 106:139–144. https://doi.org/10.1016/j.wneu.2017.06.056

    Article  PubMed  Google Scholar 

  4. Brinjikji W, Rabinstein AA, Lanzino G, Kallmes DF, Cloft HJ (2011) Effect of age on outcomes of treatment of unruptured cerebral aneurysms: a study of the National Inpatient Sample 2001-2008. Stroke 42:1320–1324. https://doi.org/10.1161/STROKEAHA.110.607986

    Article  PubMed  Google Scholar 

  5. Cai Y, Spelle L, Wang H, Piotin M, Mounayer C, Vanzin JR, Moret J (2005) Endovascular treatment of intracranial aneurysms in the elderly: single-center experience in 63 consecutive patients. Neurosurgery 57:1096–1102. https://doi.org/10.1227/01.neu.0000185583.25420.df

    Article  PubMed  Google Scholar 

  6. Chalouhi N, Jabbour P, Singhal S, Drueding R, Starke RM, Dalyai RT, Tjoumakaris S, Gonzalez LF, Dumont AS, Rosenwasser R, Randazzo CG (2013) Stent-assisted coiling of intracranial aneurysms: predictors of complications, recanalization, and outcome in 508 cases. Stroke 44:1348–1353. https://doi.org/10.1161/STROKEAHA.111.000641

    Article  PubMed  Google Scholar 

  7. Chalouhi N, Jabbour P, Tjoumakaris S, Dumont AS, Chitale R, Rosenwasser RH, Gonzalez LF (2013) Single-center experience with balloon-assisted coil embolization of intracranial aneurysms: safety, efficacy and indications. Clin Neurol Neurosurg 115:607–613. https://doi.org/10.1016/j.clineuro.2012.07.028

    Article  PubMed  Google Scholar 

  8. Chalouhi N, Thakkar V, Tjoumakaris S, Fernando Gonzalez L, Hasan D, Rosenwasser R, Singhal S, Jabbour PM (2014) Microsurgical clipping of large and giant cerebral aneurysms: a single-center contemporary experience. J Clin Neurosci 21:1424–1427. https://doi.org/10.1016/j.jocn.2013.11.052

    Article  PubMed  Google Scholar 

  9. Chalouhi N, Tjoumakaris S, Gonzalez LF, Dumont AS, Starke RM, Hasan D, Wu C, Singhal S, Moukarzel LA, Rosenwasser R, Jabbour P (2014) Coiling of large and giant aneurysms: complications and long-term results of 334 cases. AJNR Am J Neuroradiol 35:546–552. https://doi.org/10.3174/ajnr.A3696

    Article  CAS  Google Scholar 

  10. Choi DS, Kim MC, Lee SK, Willinsky RA, Terbrugge KG (2010) Clinical and angiographic long-term follow-up of completely coiled intracranial aneurysms using endovascular technique. J Neurosurg 112:575–581. https://doi.org/10.3171/2008.12.JNS08768

    Article  PubMed  Google Scholar 

  11. Cognard C, Pierot L, Anxionnat R, Ricolfi F, Clarity Study G (2011) Results of embolization used as the first treatment choice in a consecutive nonselected population of ruptured aneurysms: clinical results of the Clarity GDC study. Neurosurgery 69:837–841; discussion 842. https://doi.org/10.1227/NEU.0b013e3182257b30

    Article  Google Scholar 

  12. Connolly ES Jr, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, Hoh BL, Kirkness CJ, Naidech AM, Ogilvy CS, Patel AB, Thompson BG, Vespa P, American Heart Association Stroke C, Council on Cardiovascular R, Intervention, Council on Cardiovascular N, Council on Cardiovascular S, Anesthesia, Council on Clinical C (2012) Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 43:1711–1737. https://doi.org/10.1161/STR.0b013e3182587839

    Article  PubMed  Google Scholar 

  13. de Rooij NK, Linn FH, van der Plas JA, Algra A, Rinkel GJ (2007) Incidence of subarachnoid haemorrhage: a systematic review with emphasis on region, age, gender and time trends. J Neurol Neurosurg Psychiatry 78:1365–1372. https://doi.org/10.1136/jnnp.2007.117655

    Article  PubMed  PubMed Central  Google Scholar 

  14. Edwards NJ, Jones WH, Sanzgiri A, Corona J, Dannenbaum M, Chen PR (2017) Antiplatelet therapy for the prevention of peri-coiling thromboembolism in high-risk patients with ruptured intracranial aneurysms. J Neurosurg 127:1326–1332. https://doi.org/10.3171/2016.9.JNS161340

    Article  CAS  Google Scholar 

  15. Fan L, Lin B, Xu T, Xia N, Shao X, Tan X, Zhong M, Yang Y, Zhao B (2017) Predicting intraprocedural rupture and thrombus formation during coiling of ruptured anterior communicating artery aneurysms. J Neurointerventional Surg 9:370–375. https://doi.org/10.1136/neurintsurg-2016-012335

    Article  Google Scholar 

  16. Fehnel CR, Gormley WB, Dasenbrock H, Lee Y, Robertson F, Ellis AG, Mor V, Mitchell SL (2017) Advanced age and post-acute care outcomes after subarachnoid hemorrhage. J Am Heart Assoc 6. https://doi.org/10.1161/JAHA.117.006696

  17. Garbossa D, Panciani PP, Fornaro R, Crobeddu E, Marengo N, Fronda C, Ducati A, Bergui M, Fontanella M (2012) Subarachnoid hemorrhage in elderly: advantages of the endovascular treatment. Geriatr Gerontol Int 12:46–49. https://doi.org/10.1111/j.1447-0594.2011.00725.x

    Article  PubMed  Google Scholar 

  18. Gherasim DN, Gory B, Sivan-Hoffmann R, Pierot L, Raoult H, Gauvrit JY, Desal H, Barreau X, Herbreteau D, Riva R, Ambesi Impiombato F, Armoiry X, Turjman F (2015) Endovascular treatment of wide-neck anterior communicating artery aneurysms using WEB-DL and WEB-SL: short-term results in a multicenter study. AJNR Am J Neuroradiol 36:1150–1154. https://doi.org/10.3174/ajnr.A4282

    Article  CAS  PubMed  Google Scholar 

  19. Gizewski ER, Goricke S, Wolf A, Schoch B, Stolke D, Forsting M, Wanke I (2008) Endovascular treatment of intracranial aneurysms in patients 65 years or older: clinical outcomes. AJNR Am J Neuroradiol 29:1575–1580. https://doi.org/10.3174/ajnr.A1165

    Article  CAS  PubMed  Google Scholar 

  20. Griessenauer CJ, Adeeb N, Foreman PM, Gupta R, Patel AS, Moore J, Abud TG, Thomas AJ, Ogilvy CS, Baccin CE (2016) Impact of coil packing density and coiling technique on occlusion rates for aneurysms treated with stent-assisted coil embolization. World Neurosurg 94:157–166. https://doi.org/10.1016/j.wneu.2016.06.127

    Article  PubMed  Google Scholar 

  21. Gross BA, Rosalind Lai PM, Frerichs KU, Du R (2014) Aspirin and aneurysmal subarachnoid hemorrhage. World Neurosurg 82:1127–1130. https://doi.org/10.1016/j.wneu.2013.03.072

    Article  PubMed  Google Scholar 

  22. Horowitz M, Gupta R, Jovin T (2005) The dual catheter technique for coiling of wide-necked cerebral aneurysms. An under-reported method. Int Neuroradiol 11:155–160. https://doi.org/10.1177/159101990501100206

    Article  CAS  Google Scholar 

  23. Ishii A, Chihara H, Kikuchi T, Arai D, Ikeda H, Miyamoto S (2017) Contribution of the straightening effect of the parent artery to decreased recanalization in stent-assisted coiling of large aneurysms. J Neurosurg 127:1063–1069. https://doi.org/10.3171/2016.9.JNS16501

    Article  PubMed  Google Scholar 

  24. Kato Y, Hayashi T, Tanahashi N, Kobayashi S, Japan Standard Stroke Registry Study G (2015) Influence of antiplatelet drugs on the outcome of subarachnoid hemorrhage differs with age. J Stroke Cerebrovasc Dis 24:2252–2255. https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.06.021

    Article  PubMed  Google Scholar 

  25. Molyneux AJ, Kerr RSC, Yu L-M, Clarke M, Sneade M, Yarnold JA, Sandercock P (2005) International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366:809–817. https://doi.org/10.1016/s0140-6736(05)67214-5

    Article  PubMed  Google Scholar 

  26. Ortiz R, Stefanski M, Rosenwasser R, Veznedaroglu E (2008) Cigarette smoking as a risk factor for recurrence of aneurysms treated by endosaccular occlusion. J Neurosurg 108:672–675. https://doi.org/10.3171/JNS/2008/108/4/0672

    Article  PubMed  Google Scholar 

  27. Pierot L, Cognard C, Anxionnat R, Ricolfi F, Investigators C (2010) Ruptured intracranial aneurysms: factors affecting the rate and outcome of endovascular treatment complications in a series of 782 patients (CLARITY study). Radiology 256:916–923. https://doi.org/10.1148/radiol.10092209

    Article  PubMed  Google Scholar 

  28. Pierot L, Wakhloo AK (2013) Endovascular treatment of intracranial aneurysms: current status. Stroke 44:2046–2054. https://doi.org/10.1161/STROKEAHA.113.000733

    Article  PubMed  Google Scholar 

  29. Ryttlefors M, Enblad P, Kerr RS, Molyneux AJ (2008) International subarachnoid aneurysm trial of neurosurgical clipping versus endovascular coiling: subgroup analysis of 278 elderly patients. Stroke 39:2720–2726. https://doi.org/10.1161/STROKEAHA.107.506030

    Article  PubMed  Google Scholar 

  30. Sacco RL, Wolf PA, Bharucha NE, Meeks SL, Kannel WB, Charette LJ, McNamara PM, Palmer EP, D'Agostino R (1984) Subarachnoid and intracerebral hemorrhage: natural history, prognosis, and precursive factors in the Framingham study. Neurology 34:847–847. https://doi.org/10.1212/wnl.34.7.847

    Article  CAS  PubMed  Google Scholar 

  31. Shapiro M, Becske T, Sahlein D, Babb J, Nelson PK (2012) Stent-supported aneurysm coiling: a literature survey of treatment and follow-up. AJNR Am J Neuroradiol 33:159–163. https://doi.org/10.3174/ajnr.A2719

    Article  CAS  PubMed  Google Scholar 

  32. Sluzewski M, Menovsky T, Van Rooij WJ, Wijnalda D (2003) Coiling of very large or giant cerebral aneurysms: long-term clinical and serial angiographic results. AJNR Am J Neuroradiol 2:257–262

    Google Scholar 

  33. Songsaeng D, Geibprasert S, ter Brugge KG, Willinsky R, Tymianski M, Krings T (2011) Impact of individual intracranial arterial aneurysm morphology on initial obliteration and recurrence rates of endovascular treatments: a multivariate analysis. J Neurosurg 114:994–1002. https://doi.org/10.3171/2010.8.JNS10241

    Article  PubMed  Google Scholar 

  34. Toussaint LG 3rd, Friedman JA, Wijdicks EF, Piepgras DG, Pichelmann MA, McIver JI, McClelland RL, Nichols DA, Meyer FB, Atkinson JL (2004) Influence of aspirin on outcome following aneurysmal subarachnoid hemorrhage. J Neurosurg 101:921–925. https://doi.org/10.3171/jns.2004.101.6.0921

    Article  CAS  PubMed  Google Scholar 

  35. van Rooij WJ, Sluzewski M, Beute GN, Nijssen PC (2006) Procedural complications of coiling of ruptured intracranial aneurysms: incidence and risk factors in a consecutive series of 681 patients. AJNR Am J Neuroradiol 27:1498–1501

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Jingyuan Road 5, Beijing, 100043, China

    Xiangke Ma

  2. Department of Neurosurgery, University Hospital of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland

    Xiangke Ma & Yang Yang

  3. Department of Neuroradiology, Beijing Chaoyang Hospital, Capital Medical University, Jingyuan Road 5, Beijing, 100043, China

    Yiming Zhou & Weihua Jia

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  1. Xiangke Ma
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Correspondence to Xiangke Ma.

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The authors declare that they have no conflicts of interest.

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Approval for the retrospective study was obtained from the research ethics committee of Chaoyang Hospital affiliated with the Capital Medical University.

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All individual participants included in the study provided informed consent.

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Ma, X., Yang, Y., Zhou, Y. et al. Endovascular treatment of ruptured intracranial aneurysms in elderly patients: clinical features and treatment outcome. Neurosurg Rev 42, 745–751 (2019). https://doi.org/10.1007/s10143-018-1031-4

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  • DOI: https://doi.org/10.1007/s10143-018-1031-4

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