Journal article
Age-related differences in unruptured intracranial aneurysms: 1-year outcomes
Journal of neurosurgery, Vol.121(5), pp.1024-1038
11/2014
DOI: 10.3171/2014.6.jns121179
PMID: 25170670
Abstract
The aim of this study was to determine age-related differences in short-term (1-year) outcomes in patients with unruptured intracranial aneurysms (UIAs).
Four thousand fifty-nine patients prospectively enrolled in the International Study of Unruptured Intracranial Aneurysms were categorized into 3 groups by age at enrollment: < 50, 50-65, and > 65 years old. Outcomes assessed at 1 year included aneurysm rupture rates, combined morbidity and mortality from aneurysm procedure or hemorrhage, and all-cause mortality. Periprocedural morbidity, in-hospital morbidity, and poor neurological outcome on discharge (Rankin scale score of 3 or greater) were assessed in surgically and endovascularly treated groups. Univariate and multivariate associations of each outcome with age were tested.
The risk of aneurysmal hemorrhage did not increase significantly with age. Procedural and in-hospital morbidity and mortality increased with age in patients treated with surgery, but remained relatively constant with increasing age with endovascular treatment. Poor neurological outcome from aneurysm- or procedure-related morbidity and mortality did not differ between management groups for patients 65 years old and younger, but was significantly higher in the surgical group for patients older than 65 years: 19.0% (95% confidence interval [CI] 13.9%-24.4%), compared with 8.0% (95% CI 2.3%-13.6%) in the endovascular group and 4.2% (95% CI 2.3%-6.2%) in the observation group. All-cause mortality increased steadily with increasing age, but differed between treatment groups only in patients < 50 years of age, with the surgical group showing a survival advantage at 1 year.
Surgical treatment of UIAs appears to be safe, prevents 1-year hemorrhage, and may confer a survival benefit in patients < 50 years of age. However, surgery poses a significant risk of morbidity and death in patients > 65 years of age. Risk of endovascular treatment does not appear to increase with age. Risks and benefits of treatment in older patients should be carefully considered, and if treatment is deemed necessary for patients older than 65 years, endovascular treatment may be the best option.
Details
- Title: Subtitle
- Age-related differences in unruptured intracranial aneurysms: 1-year outcomes
- Creators
- Kelly B Mahaney - Department of Neurosurgery, Carver College of Medicine, University of Iowa, Iowa City, Iowa;Robert D Brown JrIrene MeissnerDavid G PiepgrasJohn Huston IIIJie ZhangJames C TornerISUIA Investigators
- Resource Type
- Journal article
- Publication Details
- Journal of neurosurgery, Vol.121(5), pp.1024-1038
- DOI
- 10.3171/2014.6.jns121179
- PMID
- 25170670
- NLM abbreviation
- J Neurosurg
- ISSN
- 1933-0693
- eISSN
- 1933-0693
- Publisher
- United States
- Grant note
- R01-NS-28492 / NINDS NIH HHS
- Language
- English
- Date published
- 11/2014
- Academic Unit
- Epidemiology; Surgery; Injury Prevention Research Center; Neurosurgery
- Record Identifier
- 9983996078602771
Metrics
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