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Neurosurgery. 2010 Apr;66(4):714-20; discussion 720-1. doi: 10.1227/01.NEU.0000367451.59090.D7.

Endovascular coiling of intracranial aneurysms in elderly patients: report of 205 treated aneurysms.

Author information

1
Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA. ngonzalez@mednet.ucla.edu

Abstract

BACKGROUND:

More elderly patients are presenting with intracranial aneurysms. Many are poor surgical candidates and often undergo endovascular treatment.

OBJECTIVE:

We present our experience with embolization in elderly patients.

METHODS:

We performed a retrospective review of a prospective database of elderly patients treated with coil embolization for intracranial aneurysms.

RESULTS:

In a period of 16 years, 205 aneurysms were treated in 196 individuals (age range, 70-96 years; mean age, 77.3 years), including 159 females (average follow-up, 16.2 months). Ninety-seven patients presented with unruptured aneurysms, and 99 patients presented after subarachnoid hemorrhage; the diagnosis was confirmed by computed tomographic scan or lumbar puncture. Complete occlusion was achieved in 53 aneurysms (26%), with a neck remnant in 127 (62%), incomplete occlusion in 13 (6%), and 12 unsuccessful attempts. Postembolization, 89.3% of patients were neurologically intact or unchanged, whereas 8.7% had new deficits. Four patients died. By modified Rankin Scale score, at last clinical evaluation, 128 patients (65%) had a good outcome. Follow-up angiograms were available for 113 aneurysms; they revealed that 62% were unchanged, 21% were further thrombosed, and 17% had recanalized. Three aneurysms ruptured after treatment during follow-up. Rupture was not associated with incomplete occlusion or neck remnant results (P = .6). Twenty-five aneurysms required reembolization. Reembolization was not associated with new deficits or death (odds ratio, 0.56; 95% confidence interval, 0.19-1.58; P = .27).

CONCLUSION:

Coil embolization of intracranial aneurysms is safe and effective in the elderly. Preembolization clinical condition strongly correlates with clinical outcome. Incomplete embolizations are not associated with a higher rerupture risk. Additional embolization does not affect the clinical results.

[Indexed for MEDLINE]

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