Endovascular Coiling of Intracranial Aneurysms in Elderly Patients

Abstract

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.