Endovascular Treatment of Unruptured Wide Necked Cerebral Aneurysms Larger Than 9 mm Affects Re-treatment and Prognosis in the Elderly: A Retrospective Analysis of Unruptured Aneurysms.

Background and purpose The risk of rupture increases with advancing age. However, the risk-benefit of coil embolization for elderly patients with unruptured aneurysms is controversial. This study aimed to identify factors associated with treatment primary outcomes, including risk factors for complications and aneurysm recurrence requiring re-treatment in the endovascular treatment of unruptured aneurysms in elderly patients. In addition, deterioration of the modified Rankin Scale (mRS) was examined as a secondary outcome. Materials and methods This retrospective three-center study examined 112 cases of coiled unruptured aneurysms in patients aged ≥ 60 years using endovascular registry data from January 2018 to March 2022. We examined patient background, aneurysm characteristics, adjuvant technique, symptomatic complications, and mRS scores. Results The average age of the patients was 72.5±6.9 years, and 83 cases (74.1%) were female. During the postoperative follow-up period (six to 36 months), no deaths occurred, one case of postoperative rupture was observed, and nine patients (5.4%) were re-treated. Notably, age, underlying disease, aneurysm location, and re-treatment were not associated with complications. In the multivariate logistic analysis for re-treatment, symptomatic complications [odds ratio (OR) 11.01; 95% confidence interval (CI), 3.68-52.5; p < 0.001] and re-treatment (OR 3.25; 95% CI, 1.04-10.7; p = 0.039) were independently associated with mRS score deterioration. The risk factors for re-treatment were maximum aneurysm diameter and aneurysm neck diameter; aneurysms with neck diameters and maximum diameters > 5.0 mm and > 9.0 mm, respectively, had a higher rate of need for re-treatment (33%) and mRS score deterioration (33%) due to re-enlargement of the aneurysm. Conclusion In this study, complications did not increase with age in those aged 60 and older. However, prioritizing the avoidance of complications in elderly patients is important. Elderly patients with aneurysms larger than 9 mm have a poor prognosis and require additional attention for re-treatment.