Chernyshev Oleg Y, Bir Shyamal C, Maiti Tanmoy K, Patra Devi Prasad, Liendo Cesar, Cuellar Hugo, Minagar Alireza, Nanda Anil
Department of Neurology and Sleep Medicine, LSU Health-Shreveport, 1501 Kings Highway, Shreveport, LA 71130-3932, USA.
Department of Neurosurgery, LSU Health-Shreveport, 1501 Kings Highway, Shreveport, LA 71130-3932, USA.
J Clin Neurosci. 2017 Sep;43:94-102. doi: 10.1016/j.jocn.2017.05.015. Epub 2017 Jun 7.
Optimal treatment of intracranial aneurysms (IAs) in elderly patients has not yet been well established. We have investigated the clinical and radiological outcomes and predictors of unfavorable outcome of IAs in elderly patients. Radiological and clinical data of 85 elderly patients from 2010 through 2015 were retrospectively reviewed. Significant differences between the groups were determined by a chi-square test. Regression analysis was performed to identify the predictors of unfavorable outcome. Among the 85 patients with IAs, the number of patients with >7mm size aneurysm (p=0.01), diabetes mellitus (DM) (p=0.02), smoking (0.009) and Hunt and Hess grade 4-5 (p=0.003) was significantly higher in the ruptured group compared to the unruptured group. Similarly, the number of patients who underwent clipping was higher in the ruptured aneurysm group (p=0.01). The overall clinical outcome was comparatively better in the unruptured group (p=0.03); however, microsurgical clipping of aneurysms provides a significantly higher rate of complete aneurysmal occlusion (p=0.008). Overall, there was no significant difference in outcome in respect to treatment approach. In regression analysis, hypertension (HTN), obstructive sleep apnea (OSA), prior stroke, ruptured aneurysms and partial occlusion of aneurysms were identified as predictors of unfavorable outcome of IAs. Intracranial aneurysms in elderly patients reveals that endovascular treatment provides better clinical outcome; however, microsurgical clipping yields higher complete occlusion. Retreatment of residual aneurysms was comparatively more in the coiling group. Practice pattern has shifted from clipping to coiling for aneurysms in posterior circulation but not for aneurysms in anterior circulation.
老年患者颅内动脉瘤（IA）的最佳治疗方法尚未完全确立。我们研究了老年患者IA的临床和影像学结果以及不良预后的预测因素。回顾性分析了2010年至2015年85例老年患者的影像学和临床资料。采用卡方检验确定组间的显著差异。进行回归分析以确定不良预后的预测因素。在85例IA患者中，破裂组动脉瘤直径>7mm（p=0.01）、糖尿病（DM）（p=0.02）、吸烟（0.009）以及Hunt和Hess分级4-5级（p=0.003）的患者数量显著高于未破裂组。同样，破裂动脉瘤组接受夹闭手术的患者数量更多（p=0.01）。未破裂组的总体临床结局相对较好（p=0.03）；然而，动脉瘤显微夹闭术的动脉瘤完全闭塞率显著更高（p=0.008）。总体而言，治疗方法在结局方面无显著差异。回归分析显示，高血压（HTN）、阻塞性睡眠呼吸暂停（OSA）、既往卒中、破裂动脉瘤以及动脉瘤部分闭塞是IA不良预后的预测因素。老年患者颅内动脉瘤的研究表明，血管内治疗可提供更好的临床结局；然而，显微夹闭术的完全闭塞率更高。栓塞组残余动脉瘤的再次治疗相对更多。后循环动脉瘤的治疗模式已从夹闭转向栓塞，但前循环动脉瘤并非如此。
