Department of Neurological Surgery, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Department of Neurology, University of Pittsburgh Medical Center Stroke Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
World Neurosurg. 2024 Oct;190:e883-e890. doi: 10.1016/j.wneu.2024.08.031. Epub 2024 Aug 10.
Treatment outcomes of octogenarians with aneurysmal subarachnoid hemorrhage (aSAH) are often considered poor. With ongoing advancements and experience in endovascular technology, we sought to evaluate the outcomes of octogenarians treated for aSAH in the second post-International Subarachnoid Aneurysm Trial (ISAT)/Barrow Ruptured Aneurysm Trial (BRAT) decade.
A single-center database of aSAH was reviewed to identify patients aged 80 years or above undergoing aneurysm treatment. Mortality and favorable neurologic outcome (defined as modified Rankin Scale score <3) were assessed among the series and compared across several subgroups.
Octogenarian patients constituted 6% of the aSAH cohort (38 of 619) over the reviewed period. Twenty-one percent were high grade (Hunt-Hess grade 4-5). Endovascular treatment was the first-line modality in 90% of patients. During a median follow-up of 17 months, the overall mortality was 39%. Higher mortality was associated with poor Hunt-Hess grade (100% for grade 5, 47% for III-IV, 13% for 1-2, P = 0.004) and non-independent baseline function status (100% mortality for non-independent vs. 28% for independent group, P = 0.002). At last follow-up, 53% of patients achieved a favorable neurologic outcome. The stratified rate was 80% in Hunt-Hess grade I-II and over 60% in patients with premorbid independent function status or less than 5 frailty components (P ≤ 0.02 vs. poorer counterparts).
Neurologic outcomes of octogenarian patients with aSAH are improving in the second post-trial decade, particularly given the preponderance of endovascular treatment. Baseline functional status and comorbidities of octogenarians should be considered in addition to the Hunt-Hess grade in prognostication.
高龄患者（80 岁及以上）蛛网膜下腔出血（aSAH）的治疗效果通常较差。随着血管内治疗技术的不断发展和经验积累，我们旨在评估在国际蛛网膜下腔动脉瘤试验（ISAT）/巴罗破裂动脉瘤试验（BRAT）后第二个十年中接受 aSAH 治疗的高龄患者的治疗效果。
回顾性分析单一中心的 aSAH 数据库，以确定接受动脉瘤治疗的年龄 80 岁及以上的患者。评估该系列患者的死亡率和良好的神经功能预后（定义为改良 Rankin 量表评分＜3），并比较几个亚组之间的差异。
在研究期间，高龄患者占 aSAH 患者的 6%（38/619）。21%为高分级（Hunt-Hess 分级 4-5 级）。90%的患者采用血管内治疗作为一线治疗方式。中位随访 17 个月时，总体死亡率为 39%。较差的 Hunt-Hess 分级（5 级死亡率为 100%，3-4 级为 47%，1-2 级为 13%，P=0.004）和非独立基线功能状态（非独立组死亡率为 100%，独立组为 28%，P=0.002）与较高的死亡率相关。末次随访时，53%的患者获得了良好的神经功能预后。Hunt-Hess 分级 I-II 级患者的分层比例为 80%，且有独立功能状态或合并症少于 5 项（衰弱指数）的患者的分层比例＞60%（P≤0.02 比预后较差的患者）。
在试验后第二个十年，高龄患者蛛网膜下腔出血的神经功能预后正在改善，尤其是考虑到血管内治疗的优势。除了 Hunt-Hess 分级外，还应考虑高龄患者的基线功能状态和合并症对预后的影响。
