Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan.
Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan.
World Neurosurg. 2024 Jan;181:e273-e290. doi: 10.1016/j.wneu.2023.10.039. Epub 2023 Oct 13.
The opportunities to treat elderly patients with aneurysmal subarachnoid hemorrhage (aSAH) are increasing globally, but the outcome remains poor. This study seeks to investigate treatment-related factors that can modify functional outcomes in patients with aSAH aged ≥75 years.
A total of 202 patients with aSAH aged ≥75 years prospectively enrolled in 9 primary stroke centers from 2013 to 2021 were retrospectively analyzed. Clinical variables including treatments for hydrocephalus, angiographic vasospasm, and delayed cerebral ischemia were compared between patients with good (modified Rankin Scale [mRS] score 0-2) and poor (mRS score 3-6) outcomes at 90 days from onset, followed by multivariate analyses to find independent outcome determinants. A modifiable treatment-related variable was evaluated after propensity score matching with adjustments for age, sex, pre-onset mRS score, aSAH severity, and treatment modality.
More than half of patients showed World Federation of Neurological Societies grades IV-V on admission. Univariate analyses showed that advanced age, worse pre-onset mRS score, more severe neurologic status on admission, higher modified Fisher grade on admission computed tomography scans, and acute and chronic hydrocephalus were associated with poor outcomes. In contrast, administration of a phosphodiesterase type III inhibitor, cilostazol, was associated with good outcomes in both univariate (P = 0.036) and multivariate analyses (adjusted odds ratio, 0.305; 95% confidence interval, 0.097-0.955; P = 0.042). Propensity score matching analyses showed that patients treated with cilostazol had better outcomes (P = 0.016) with fewer incidences of delayed cerebral infarction (P = 0.008).
Even in patients with aSAH aged ≥75 years, cilostazol administration may lead to better outcomes by suppressing the development of delayed cerebral infarction.
全球范围内，治疗老年动脉瘤性蛛网膜下腔出血（aSAH）患者的机会正在增加，但结果仍然不佳。本研究旨在探讨与治疗相关的因素，这些因素可以改善年龄≥75 岁的 aSAH 患者的功能结局。
回顾性分析了 2013 年至 2021 年期间，9 个初级卒中中心共 202 例年龄≥75 岁的 aSAH 患者的前瞻性登记资料。比较了发病后 90 天预后良好（改良 Rankin 量表[mRS]评分 0-2）和预后不良（mRS 评分 3-6）患者的脑积水治疗、血管造影性血管痉挛和迟发性脑缺血等临床变量，随后进行多变量分析以确定独立的预后决定因素。在经过年龄、性别、发病前 mRS 评分、aSAH 严重程度和治疗方式的倾向评分匹配调整后，评估了一个可改变的与治疗相关的变量。
超过一半的患者入院时表现为世界神经外科联盟[WFNS]分级Ⅳ-Ⅴ级。单因素分析显示，高龄、发病前 mRS 评分较差、入院时神经功能状态更差、入院 CT 扫描改良 Fisher 分级更高、急性和慢性脑积水与不良预后相关。相反，磷酸二酯酶 3 抑制剂西洛他唑的使用与单因素（P=0.036）和多因素分析（调整优势比，0.305；95%置信区间，0.097-0.955；P=0.042）均相关。倾向评分匹配分析显示，接受西洛他唑治疗的患者结局更好（P=0.016），迟发性脑梗死发生率更低（P=0.008）。
即使在年龄≥75 岁的 aSAH 患者中，西洛他唑的使用也可能通过抑制迟发性脑梗死的发生来改善预后。
