在韩国进行的一项全国性队列研究：老年未破裂脑动脉瘤患者夹闭术和血管内栓塞术的临床结局。
Clinical Outcomes of Clipping and Coiling in Elderly Patients with Unruptured Cerebral Aneurysms: a National Cohort Study in Korea.
机构信息
Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
出版信息
J Korean Med Sci. 2021 Jul 5;36(26):e178. doi: 10.3346/jkms.2021.36.e178.
BACKGROUND
We aimed to analyze outcomes of clipping and coiling in treating unruptured intracranial aneurysms (UIAs) in elderly patients and to identify the age at which perioperative risk increases based on national cohort data in South Korea.
METHODS
The incidence of perioperative intracranial hemorrhage (ICRH), perioperative cerebral infarction (CI), mortality, and moderate to severe disability data of the patients who underwent coiling or clipping for UIAs were retrieved. Estimated breakpoint (EBP) was calculated to identify the age at which the risk of treatment increases.
RESULTS
A total of 38,207 patients were treated for UIAs. Among these, 22,093 (57.8%) patients underwent coiling and 16,114 (42.2%) patients underwent clipping. The incidence of ICRH, requiring a secondary operation, within 3 months in patients ≥ 65 years that underwent coiling and clipping was 1.13% and 4.81%, respectively, and that of both groups assessed were significantly higher in patients ≥ 75 years (coiling, = 0.013, relative risk (RR) 1.81; clipping, = 0.015) than younger patients. The incidence of CI within 3 months in patients aged ≥ 65 was 13.90% and 9.19% in the coiling and clipping groups, respectively. The incidence of CI after coiling in patients aged ≥ 75 years ( < 0.001, RR 1.96) and after clipping in patients aged ≥ 70 years ( < 0.001, RR 1.76) was significantly higher than that in younger patients. The mortality rates within 1 year in patients with perioperative ICRH or CI were 2.41% and 3.39% for coiling and clipping groups, respectively, in patients ≥ 65. These rates increased significantly at age 70 in the coiling group and at age 75 for the clipping group ( = 0.012 and < 0.001, respectively).
CONCLUSION
The risk of treatment increases with age, and this risk increases dramatically in patients aged ≥ 70 years. Therefore, the treatment decisions in patients aged ≥ 70 years should be made with utmost care.
背景
本研究旨在通过韩国全国队列数据，分析高龄患者颅内未破裂动脉瘤（UIAs）夹闭和血管内介入治疗的结果，并确定围手术期风险增加的年龄。
方法
检索接受血管内介入治疗或夹闭治疗 UIAs 的患者围手术期颅内出血（ICH）、围手术期脑梗死（CI）、死亡率和中重度残疾数据。计算估计断点（EBP）以确定治疗风险增加的年龄。
结果
共 38207 例患者因 UIAs 接受治疗。其中 22093 例（57.8%）患者接受血管内介入治疗，16114 例（42.2%）患者接受夹闭治疗。年龄≥65 岁患者血管内介入治疗后 3 个月内 ICRH 需要再次手术的发生率分别为 1.13%和 4.81%，≥75 岁患者发生率明显高于年龄较轻患者（血管内介入治疗， = 0.013，相对危险度（RR）为 1.81；夹闭治疗， = 0.015）。年龄≥65 岁患者围手术期 3 个月内 CI 的发生率分别为血管内介入治疗组 13.90%和夹闭治疗组 9.19%。年龄≥75 岁患者血管内介入治疗后 CI 发生率（<0.001，RR 1.96）和年龄≥70 岁患者夹闭治疗后 CI 发生率（<0.001，RR 1.76）明显高于年龄较轻患者。血管内介入治疗或夹闭治疗后围手术期 ICRH 或 CI 的患者 1 年内死亡率分别为血管内介入治疗组 2.41%和夹闭治疗组 3.39%，年龄≥65 岁患者死亡率明显升高，血管内介入治疗组在 70 岁时（ = 0.012）和夹闭治疗组在 75 岁时（<0.001）显著升高。
结论
随着年龄的增长，治疗风险增加，≥70 岁患者的风险显著增加。因此，≥70 岁患者的治疗决策应格外谨慎。
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