Clinical outcomes of treatment for intracranial aneurysm in elderly patients.
Clinical outcomes of treatment for intracranial aneurysm in elderly patients.
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DOI：
10.7461/jcen.2014.16.3.193
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发表时间：
2014-09
期刊：
影响因子：
--
通讯作者：
Lim YC
中科院分区：
文献类型：
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作者：
Park JH;Kim YI;Lim YC
本研究的目的是评价65岁及以上患者颅内动脉瘤的临床病程及其积极治疗后的即时结局。我们对2008年9月至2013年12月在我院接受治疗的159例老年患者的病历进行了回顾性分析。获得的临床信息包括年龄、性别、Hunt和Hess分级（HHG）、动脉瘤位置、Fisher分级（FG）和治疗方式。评价了除脑血管疾病（高血压、糖尿病、既往用药）以外的伴随临床数据，以确定可能影响功能结局的风险因素。共有108例（67.9%）患者出现蛛网膜下腔出血（SAH），51例（32.1%）患者出现未破裂颅内动脉瘤（UIA）。101例患者接受弹簧圈栓塞术，58例患者接受夹闭术。在SAH人群中，62例患者（57.4%）显示出良好结局，死亡率为11.3%（n = 18）。在UIA人群中，50例（98%）患者达到“极好”结局，1例（2%）达到“良好”结局。高级别HHG（p < 0.001）、高龄（p = 0.014）和脑室内血肿（IVH）（p = 0.017）是预后不良的重要预测因素。SAH合并高级别HHG和IVH患者预后差，且年龄越大预后越差。因此，在这些患者中应更仔细地考虑积极治疗的适应症。然而，由于无论治疗方式如何，患有UIA的老年患者的结局都很好，因此在UIA病例中始终可以考虑积极治疗。
The aim of this study is to evaluate the clinical course of intracranial aneurysm in patients aged 65 years and older and the immediate outcome after its aggressive management. We performed a retrospective analysis using the medical records of 159 elderly patients managed at our institute from September 2008 to December 2013. Obtained clinical information included age, sex, Hunt and Hess grade (HHG), aneurysm location, Fisher grade (FG) and the treatment modality. Concomitant clinical data aside from cerebrovascular condition (hypertension, diabetes, previous medication) were evaluated to determine risk factors that might affect the functional outcomes. A total of 108 patients (67.9%) presented with subarachnoid hemorrhage (SAH), and 51 (32.1%) with unruptured intracranial aneurysms (UIAs). Coiling was performed in 101 patients and 58 patients underwent clipping. In the SAH population, 62 patients (57.4%) showed favorable outcomes, with a mortality rate of 11.3% (n = 18). In the UIAs population, 50 (98%) patients achieved 'excellent' and one (2%) achieved 'good' outcome. Factors including high-grade HHG (p < 0.001), advanced age (p = 0.014), and the presence of intraventricular hematoma (IVH) (p = 0.017) were significant predictors of poor outcome. SAH patients with high grade HHG and IVH are associated with poor outcome with statistical significance, all the more prominent the older the patient is. Therefore, the indication for aggressive therapy should be considered more carefully in these patients. However, as the outcomes for elderly patients with UIAs were excellent regardless of the treatment modality, aggressive treatment could always be considered in UIAs cases.