Treatment of elderly patients with aneurysmal subarachnoid hemorrhage: comparison between surgical clipping and endovascular coil embolization
10.3760/cma.j.issn.1673-4165.2019.09.008
- VernacularTitle: 老年动脉瘤性蛛网膜下腔出血患者的治疗：手术夹闭与血管内弹簧圈栓塞比较
- Author:
Chaobo LIU
1
;
Li REN
;
Hao XU
;
Jin XING
;
Huanbin HUANG
;
Zhihan WANG
;
Xihua WANG
Author Information
1. Department of Neurosurgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai 201399, China
- Publication Type:Clinical Trail
- Keywords:
Subarachnoid hemorrhage;
Intracranial aneurysm;
Aneurysm, ruptured;
Embolization, therapeutic;
Endovascular procedures;
Old people;
Treatment outcome
- From:
International Journal of Cerebrovascular Diseases
2019;27(9):679-684
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the treatment effect of surgical clipping and endovascular coil embolization for aneurysmal subarachnoid hemorrhage (aSAH) in the elderly.
Methods:Elderly patients with aSAH (aged >65 years) treated in Shanghai Pudong Hospital from January 2009 to December 2017 were enrolled retrospectively. They were divided into craniotomy clipping group and endovascular intervention group according to the treatment strategy. The Glasgow Outcome Scale was used for short-term outcome assessment at discharge, 4-5 were defined as good outcome, and 1-3 were defined as poor outcome. Long-term follow-up was performed to assess clinical outcomes using the modified Rankin Scale, 0-2 was defined as good outcome and 3-6 were defined as poor outcome. The clinical and imaging information, perioperative complications, short-term and long-term clinical outcomes, and long-term imaging outcomes were compared between the two groups. Multivariate logistic regression analysis was used to assess the independent influencing factors of clinical outcomes.
Results:A total of 68 elderly patients with aSAH were enrolled. Of these, 47 (69.1%) received endovascular coil embolization and 21 (30.9%) underwent microsurgical clipping. There were no significant differences between the two groups in the incidence of perioperative complications, short-term and long-term adverse outcomes, and imaging recurrence rate. Multivariate logistic analysis showed that smoking (odds ratio [OR] 36.319, 95% confidence interval [CI] 3.530-373.640; P=0.003), modified Fisher grade (OR 20.406, 95% CI 2.022-205.964; P=0.011) and World Federation of Neurological Societies (WFNS) grade (OR 4.686, 95% CI 1.012-21.692; P=0.048) were the independent risk factors for short-term poor outcomes in elderly patients with aSAH.
Conclusion:Both endovascular intervention and microsurgical clipping are safe and effective treatments for elderly patients with aSAH.
