Johansson M, Norbäck O, Gál G, Cesarini K G, Tovi M, Solander S, Contant C F, Ronne-Engström E, Enblad P
Department of Neuroscience, Section of Neurosurgery, Uppsala University Hospital, S-751 85, Uppsala, Sweden.
Neuroradiology. 2004 May;46(5):385-91. doi: 10.1007/s00234-004-1170-x. Epub 2004 Apr 17.
Subarachnoid hemorrhage (SAH) is not an unusual disease in an elderly population. The clinical outcome has improved over time. It has been suggested that elderly SAH patients would benefit from endovascular aneurysm treatment. The aim of this study was to evaluate technical results and clinical outcome in a series of elderly SAH-patients treated with endovascular coil embolization. Sixty-two patients (> or = 65 years) presenting with aneurysmal SAH underwent early endovascular coil embolization at Uppsala University Hospital between September 1996 and December 2000. In all 62 cases included in the study, endovascular coil embolization was considered the first line of treatment. Admission variables, specific information on technical success, degree of occlusion and procedural complications, and outcome figures were recorded. Clinical grade on admission was Hunt and Hess (H&H) I-II in 39%, H&H III in 27% and H&H IV-V in 34% of the patients. The proportion of posterior circulation aneurysms was 24%. Coil embolization was successfully completed in 94%. The degree of occlusion of the treated aneurysm was complete occlusion in 56%, neck remnant in 21%, residual filling in 11%, other remnant in 5% and not treated in 6%. The rate of procedural complications was 11%. Outcome after 6 months was favorable in 41%, severe disability in 36% and poor in 22%. Favorable outcome was achieved in 57% of the H&H I-II patients, 47% of the H&H III patients and 17% of the H&H IV-V patients. Endovascular aneurysm treatment can be performed in elderly patients with SAH with a high level of technical success, acceptable aneurysm occlusion results, an acceptable rate of procedural complications and fair outcome results.
蛛网膜下腔出血（SAH）在老年人群中并非罕见疾病。随着时间推移，临床结局有所改善。有人提出老年SAH患者可从血管内动脉瘤治疗中获益。本研究的目的是评估一系列接受血管内弹簧圈栓塞治疗的老年SAH患者的技术结果和临床结局。1996年9月至2000年12月期间，62例（≥65岁）动脉瘤性SAH患者在乌普萨拉大学医院接受了早期血管内弹簧圈栓塞治疗。在本研究纳入的所有62例病例中，血管内弹簧圈栓塞被视为一线治疗方法。记录了入院变量、关于技术成功、闭塞程度和手术并发症的具体信息以及结局数据。入院时临床分级为Hunt和Hess（H&H）I-II级的患者占39%，H&H III级的占27%，H&H IV-V级的占34%。后循环动脉瘤的比例为24%。弹簧圈栓塞成功完成的比例为94%。治疗的动脉瘤闭塞程度为完全闭塞的占56%，颈部残留的占21%，残余充盈的占11%，其他残留的占5%，未治疗的占6%。手术并发症发生率为11%。6个月后的结局为良好的占41%，严重残疾的占36%，差的占22%。H&H I-II级患者中57%获得良好结局，H&H III级患者中47%获得良好结局，H&H IV-V级患者中17%获得良好结局。血管内动脉瘤治疗可在老年SAH患者中进行，技术成功率高，动脉瘤闭塞结果可接受，手术并发症发生率可接受，结局结果尚可。
