Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
School of Medicine, Tulane University, New Orleans, Louisiana, USA.
World Neurosurg. 2021 Mar;147:e98-e104. doi: 10.1016/j.wneu.2020.11.139. Epub 2020 Dec 1.
Older patients have a higher risk for poor neurological outcomes following aneurysmal subarachnoid hemorrhage (aSAH). This study compared functional independence in older versus younger patients with aSAH and compared endovascular coiling with microsurgical clipping in the older cohort.
Patients enrolled in the Barrow Ruptured Aneurysm Trial (BRAT) with confirmed aSAH were analyzed. Patients were grouped by age: older (≥65 years old) or younger (<65 years old). The primary outcome analyzed was functional independence at long-term follow-up, defined as Barthel index >80 at 6-year follow-up. A second analysis was performed comparing functional independence in older patients treated with endovascular coiling versus microsurgical clipping.
Of 405 patients with aSAH enrolled in BRAT, 77 (19%) were ≥65 years old, and 328 (81%) were <65 years old. A lower percentage of older versus younger patients was functionally independent (Barthel index >80) at 6-year follow-up (42.0% [29/69] vs. 82.2% [217/264]; P < 0.001). A higher percentage of younger patients (69.7% [184/264]) had good neurological outcomes (modified Rankin Scale score <3) at 6-year follow-up compared with older patients (31.9% [22/69]; P < 0.001). A greater percentage of older patients treated with microsurgical clipping (51.0% [18/47]) versus endovascular coiling (22.7% [5/22]) had functional independence at 6-year follow-up (P < 0.04).
Patients ≥65 years old with aSAH are at increased risk for poor neurological outcomes compared with younger patients. Greater independence was observed in older patients after microsurgical clipping than after endovascular coiling at long-term follow-up.
老年患者在蛛网膜下腔出血（aSAH）后发生神经功能不良结局的风险较高。本研究比较了老年与年轻 aSAH 患者的功能独立性，并比较了老年患者中血管内介入治疗与显微手术夹闭的效果。
分析了参与巴罗破裂性动脉瘤试验（BRAT）且确诊为 aSAH 的患者。患者按年龄分组：老年（≥65 岁）或年轻（＜65 岁）。主要分析的结果是长期随访时的功能独立性，定义为 6 年随访时巴氏指数＞80。还进行了第二项分析，比较了血管内介入治疗与显微手术夹闭治疗的老年患者的功能独立性。
BRAT 共纳入 405 例 aSAH 患者，77 例（19%）≥65 岁，328 例（81%）＜65 岁。在 6 年随访时，老年患者的功能独立性（巴氏指数＞80）比例低于年轻患者（42.0%[29/69] vs. 82.2%[217/264]；P＜0.001）。在 6 年随访时，年轻患者的良好神经功能结局（改良 Rankin 量表评分＜3）比例（69.7%[184/264]）高于老年患者（31.9%[22/69]；P＜0.001）。接受显微手术夹闭的老年患者（51.0%[18/47]）比接受血管内介入治疗的老年患者（22.7%[5/22]）在 6 年随访时功能独立性更高（P＜0.04）。
与年轻患者相比，年龄≥65 岁的 aSAH 患者神经功能不良结局风险更高。在长期随访中，接受显微手术夹闭的老年患者比接受血管内介入治疗的患者具有更高的独立性。
