Luo Chao-Bao, Teng Michael Mu-Huo, Chang Feng-Chi, Chang Cheng-Yen
Department of Radiology, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan.
J Clin Neurosci. 2007 Feb;14(2):127-32. doi: 10.1016/j.jocn.2006.05.018. Epub 2006 Nov 17.
The decision to manage ruptured cerebral aneurysms (RCAs) aggressively in elderly patients remains difficult because of inherent procedural risks and patient comorbidities. The purpose of this study was to report our experiences with and outcomes of endovascular embolization of RCAs in patients older than 70years. We studied 25 patients older than 70years with RCAs treated by endovascular embolization. There were 10 men and 15 women with a mean age of 77years. Subarachnoid haemorrhages of grades 1-3 were found in 24 patients, and one patient had grade 4 subarachnoid haemorrhage. Twenty-two RCAs were located in the anterior circulation, and three were in the posterior circulation. Seventeen RCAs were wide-necked aneurysms and five had to undergo stent-assisted coil embolization. Endovascular embolization was technically successful for all RCAs. Total angiographic obliteration of RCAs was achieved in eight (32%) cases, whereas the other 17 RCAs were subtotally or partially occluded. Procedure-related death or severe disability occurred in two patients (8%). There was no rebleeding in any patient on follow-up. Endovascular embolization of RCAs has been proven to be both safe and effective in elderly patients, and should be performed in patients for whom surgical clipping would be difficult.
由于存在固有的手术风险和患者合并症，积极治疗老年患者破裂性脑动脉瘤（RCA）的决策仍然很困难。本研究的目的是报告我们对70岁以上患者RCA进行血管内栓塞的经验和结果。我们研究了25例年龄超过70岁的RCA患者，这些患者接受了血管内栓塞治疗。其中男性10例，女性15例，平均年龄77岁。24例患者蛛网膜下腔出血分级为1 - 3级，1例患者为4级蛛网膜下腔出血。22个RCA位于前循环，3个位于后循环。17个RCA为宽颈动脉瘤，其中5个必须接受支架辅助弹簧圈栓塞。所有RCA的血管内栓塞在技术上均获成功。8例（32%）患者的RCA实现了血管造影完全闭塞，而其他17个RCA为次全或部分闭塞。2例患者（8%）发生了与手术相关的死亡或严重残疾。随访期间无患者再出血。RCA的血管内栓塞已被证明在老年患者中既安全又有效，对于难以进行手术夹闭的患者应进行该治疗。
