Abstract
Endovascular treatment of intracranial aneurysms using platinum coils was performed in 26 patien with age over 70 years. The patients ranged from 70 to 86 years old (mean 77.5). Preoperative World Federation of Neurological Surgeons (WFNS) scale revealed that 6 patients were in grade I, 5 in grade II, 2 in grade III, 12 in grade IV, and 1 in grade V. The location of aneurysms are as follows; 10 were in the internal carotid artery, 7 in the anterior cerebral artery, 1 in the middle cerebral artery, and 8 in the vertebro-basilar system. Intra-aneurysmal occlusion was accomplished in 25 patients, resulting in 6 complete occlusion (24%), 3 neck remnant (12%), 11 body filling (44%), and both of neck remnant and body filling in 5 (20%). In one patient with vertebral artery union aneurysm, the parent artery was occluded just proximal to the aneurysm.
Eleven of 13 patients with good clinical grade (grade I, II, and III) resulted in good clinical outcome, whereas 11 of 13 patients with poor clinical grade (grade IV and V) showed poor outcome. Periprocedural complications such as thromboembolism and intra-procedural rupture occurred in 5 patients (19.2%). Each of the complications was attributed to severe atherosclerotic changes of parent arteries. Symptomatic cerebral vasospasm occurred in only one patient (3.8%).
In conclusion, endovascular coil emboilization is a useful therapeutic alternative for treating ruptured intracranial aneurysms in patients over 70 years of age, especially in patients with good clinical grade (better than grade III).
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