Microsurgical Treatment versus Endovascular Treatment for Ruptured Intracranial Aneurysms in Elderly Patients: A Multicenter Study in Northern China.

BACKGROUND

Management of ruptured intracranial aneurysms (RIAs) in elderly patients remains a major challenge in the treatment of cerebrovascular diseases. This study aims to provide a comprehensive analysis of the impact of microsurgical treatment (MST) and endovascular treatment (EVT) on the outcomes of elderly patients with RIAs in northern China.

METHODS

We consecutively enrolled elderly patients with RIAs who underwent surgery in the Chinese Multicenter Cerebral Aneurysm Database (CMAD) from January 2017 to December 2020. In this study, in-hospital complications, survival, and functional outcomes were compared between MST and EVT after 1:1 propensity score matching (PSM). Kaplan-Meier survival analyses and Cox proportional hazards modeling identified factors associated with mortality in both groups. Logistic regression analyses identified 2-year survival-dependent risk factors, and subgroup analyses were conducted for key strata.

RESULTS

744 elderly patients with RIAs were enrolled in the study. 219 patients with MST after PSM were matched with 219 patients with EVT. Compared to EVT, MST had a higher 2-year mortality rate (32.8% vs. 20.5%, p = 0.002), higher incidence of adverse discharge outcomes (48.4% vs. 32.4%, p = 0.001), longer length of stay (LOS) (16 [12-24] vs. 15 [10-23], p = 0.049), pneumonia (MST: 31.1%; EVT: 21.9%, p = 0.030), and intracranial infection (9.6% vs. 2.7%, p = 0.005). However, there was no difference in the 2-year survival-dependent outcome (22.7% vs. 23.2%, p = 0.924). Differences in risk factors for mortality and 2-year survival-dependent outcomes were observed between the MST and EVT groups in the elderly population. The negative association of EVT with risk of mortality was consistent across specific subgroups.

CONCLUSION

Elderly patients with RIAs who underwent EVT were significantly better than the MST group in terms of short-term functional outcomes, in-hospital complications, long-term survival, and LOS. However, there were no differences in the 2-year survival-dependent outcomes.