We evaluate the effect of introduction of endovascular treatment with Guglielmi detachable coils (GDC) on the outcome of aged patients (>=70 years old) with subarachnoid hemorrhage (SAH).
Between 1990 and 2003, 92 aged patients with SAH underwent angiography as candidates for early aggressive treatment in our hospital. In 1990-96 (Group 1), treatment options were early craniotomy surgery, intensively delayed craniotomy surgery and conservative management (n=38), while GDC embolization at an acute stage was added to those 3 treatment options in 1997-2003 (Group 2, n=54). We compared clinical courses and outcomes assessed by Glasgow Outcome Scale (GOS) at discharge between the 2 groups.
The percentage of the patients in whom the aneurysm was occluded at an acute stage (early-treated cases) significantly increased from 47% in Group 1 to 76% in Group 2. In the early-treated cases in Group 2, GDC embolization was chosen as the treatment option in 69% of all cases (Grade I-V) and 78% of poor-graded cases (Grade IV-V). The percentage of favorable outcomes (good recovery and moderately disabled in GOS at discharge) significantly increased from 34% in Group 1 to 63% in Group 2 for all cases, and from 53% to 78% for early-treated cases. None of the poor-graded patients had a favorable outcome in Group 1, while 24% did in Group 2. In the early-treated cases in Group 2, the percentage of favorable outcomes did not differ significantly between the aged (>=70 y) and younger patients (<70 y). The incidence of symptomatic vasospasm significantly decreased from 43% in Group 1 to 13% in Group 2. The outcome of the patients with aneurysms in the internal carotid artery and basilar artery bifurcation improved significantly by the introduction of GDC embolization.
The introduction of GDC embolization expanded the indication of early treatment for aged patients with poor grade and, as a consequence, improved the outcome of those patients.