Highlights
- •Current evidence does not conclusively justify conservative management of UIAs in the elderly (age ≥ 65 years).
- •Elderly patients who undergo treatment of UIAs are prone to developing postoperative complications.
- •A high comorbidity burden correlates with a greater risk of poor treatment outcome.
- •Careful case selection based on comorbidity burden, rather than chronological age, is useful if treatment is considered.
Abstract
Current evidence does not conclusively justify conservative management of unruptured
intracranial aneurysms (UIA) in the elderly (age ≥ 65 years). To rationalise intervention,
the authors investigated the role of age and comorbidity burden on treatment outcomes.
A retrospective chart review for consecutive cases of UIAs treated in the elderly
between 2007 and 2018 was performed. Preoperative Charlson Comorbidity Index (CCI)
and Neurovascular Comorbidities Index (NCI) were calculated. Standard statistical
methods with univariate and multiple logistic regression were used. A total of 123
patients (46 surgery, 77 endovascular) with 131 UIAs were treated. The mean age was
70.6 ± 4.1 years, and 90 patients were female (73.1%). The mean aneurysm size was
8.6 ± 5.0 mm, and the mean follow up period was 22.9 ± 21.3 months. The rates of poor
outcome (mRS > 1) at discharge, 6 weeks and 6 months were 9.8%, 5.8% and 3.6%, respectively.
There was no difference in outcomes between surgical and endovascular treatment. Correlation
and regression analyses revealed that aneurysm size, higher preoperative comorbidity
index (CCI > 4), and endovascular treatment with a stent or flow diverter (p = 0.009,
0.02, and 0.005, respectively) were associated with a poor outcome. When adjusted
in a multivariate analysis, only high comorbidity burden (CCI > 4) predicted unfavourable
outcome (p = 0.01). Elderly patients who undergo treatment for UIAs are at high risk
of postoperative deterioration. Careful preoperative case selection based on comorbidity
burden, rather than chronological age, would be useful for improved risk stratification.
Keywords
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Article info
Publication history
Published online: January 14, 2019
Accepted:
January 3,
2019
Received:
September 20,
2018
Identification
Copyright
© 2019 Elsevier Ltd. All rights reserved.
