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KMID : 1159220060010010017
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Journal of Korean Society of Intravascular Neurosurgery
2006 Volume.1 No. 1 p.17 ~ p.23
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Endovascular Treatment of Intracranial Aneurysms of Elderly Patients over Sixty Five Years Old - A Clinical Research -
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Jang Jun-Won
Moon Jae-Gon
Lee Ho-Kook
Kim Hong-Dae
Kim Chang-Hyun
Hwang Do-Yun
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Abstract
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Objective：The choice of treatment modality in the elderly patients have been being under debate. With the purpose of patients and his relatives hesitating to take an operation, the frequency of endovascular GDC coil embolization is getting increasing. The authors analysed the both treatment modality between operation and coil embolization in elderly patients’ aneurysm.
Methods：Between the patients with aneurysmal neck clipping and others with endovascular treatment of intracranial aneurysms between both age groups (the older than 65 years and the less than 65 years), we analyzed aneurysmal location, size, Hunt-Hess classification on admission, clinical outcome (Glasgow Outcome Scale, GOS), vasospasm and vasospasm related complications, operation related complications and medical complications.
Results：The locations of aneurysm in clipping patients are frequent in middle cerebral bifurcation and anterior communicating artery, and those in coil embolization are in posterior and anterior communicating atery between two age groups. The size of both age groups shows different. We can find out the aneurysms in 7-12 mm size for the clipping patients more, and those in less than 7 mm size for the coil embolization patients more. There is no statistical difference the Hunt and Hess classification between two age groups. We have a statistical significance in GOS at discharge in over 65 age group but do not have a correlation in less than 65 age group. The clinical result of emboizaion treatment of unruptured patients in over 65 age group is excellent. The occurrence of the vasospasm in coil embolization is frequent in less than 65 age group but less cerebral infarction on CT scan, The vasospasm in over 65 age group do not have significant difference. The rate of operational complications and other medical complications is high in over 65 age group, however, the occurrence of complications in both clipping and coil embolization are not statistical different in both age groups.
Conclusion：In the older than 65 years group, the patients with endovascular treatment had higher GOS than others with aneurysmal neck clipping. This study revealed good clinical outcome of endovascular treatment of unruptured intracranial aneurysm of elderly patients. Although there are several restrictions such as the necessity of long term follow-up, the accessibility of the location by the endovascular procedures, and the shape of the aneurysms, we would recommend the coil embolization to the elderly patients even without medical diseases.
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KEYWORD
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Intracranial aneurysm, Endovascular treatment, Elderly patients
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