Results of treatment of aneurysmal subarachnoid hemorrhage in the elderly

Result code in IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F65269705%3A_____%2F23%3A00078399" target="_blank" >RIV/65269705:_____/23:00078399 - isvavai.cz</a>

Alternative codes found

RIV/00216224:14110/23:00132255

Result on the web

<a href="https://www.csnn.eu/en/journals/czech-and-slovak-neurology-and-neurosurgery/2023-4-7/results-of-treatment-of-aneurysmal-subarachnoid-hemorrhage-in-the-elderly-135142?hl=cs" target="_blank" >https://www.csnn.eu/en/journals/czech-and-slovak-neurology-and-neurosurgery/2023-4-7/results-of-treatment-of-aneurysmal-subarachnoid-hemorrhage-in-the-elderly-135142?hl=cs</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.48095/cccsnn2023256" target="_blank" >10.48095/cccsnn2023256</a>

Result language

čeština

Original language name

Výsledky léčby aneuryzmatického subarachnoidálního krvácení u seniorů

Original language description

Introduction: The aim of our study is to present the treatment outcomes of patients with aneurysmal subarachnoid hemorrhage (SAH) 3 months after the attack who were treated with clipping (MS) or coiling (EV). Materials and methods: The study was based on a retrospective analysis of a database of patients with cerebral aneurysms who were treated at the University Hospital Brno between 2009 and 2019. A total of 499 patients were included in the study. Of these patients, 345 (69%) were treated with surgical MS and 154 (31%) were treated with EV. Patients were divided into 4 groups: according to the age into 0-64 years and 65+ years group, and according to the modality of treatment of aneurysm by MS or EV. We evaluated the effect of the initial Hunt-Hess (HH) score on the treatment outcome according to age and modality and also the relationship between the current age of the patient and the treatment outcome at 3 months after the SAH attack, as assessed by a modified Rankin scale (mRS), where the successful treatment outcome was mRS 0-2 (self-sufficient patient), and the effect of the initial Hunt-Hess score (HH) on the treatment outcome was based on age and modality. Results: Of the 499 patients, 345 (69%) were treated with MS and 154 (31%) with EV, and the average age of MS and EV treated patients was not statistically significantly different (P = 0.2216). In both surgically and endovascularly treated patients in all age categories; we did not observe a statistically significant difference in HH score (P = 0.1664) or in graphical severity of SAH according to the Fischer score (P = 0.5041). Satisfactory treatment outcome (mRS 0-2) at 3 months after the attack was found in 49 (52.88%) in the 65+ years group after MS and 23 (60.61%) in the 65+ years group after EV. Poor treatment outcome (mRS 3-6) at 3 months was found in 43 (47.12%) in MS treated and 15 (39.39%) in EV treated patients, which was statistically signifi cant (P = 0.0002). Satisfactory treatment outcome (mRS 0-2) at 3 months with good clinical status on admission (HH 1-2) was seen in 136 (55%) patients in the 0-64 years group after MS and 28 (33%) in the 65+ years group after MS. Poor treatment outcome (mRS 3-6) after 3 months with poor initial clinical condition (HH 3-5) had 50 (20%) patients treated with MS in the 0-64 years group and 39 (44%) treated with MS in the 65+ years group, which is statistically significant (P = 0.0001). Conclusion: Elderly (65+ years) after SAH are at a higher risk of poor neurological status 3 months after the attack compared to younger patients, especially if they are in a severe clinical condition on admission. However, a significant proportion of these patients remain in a good clinical condition after treatment of an aneurysm, so the method of treatment and extent of treatment needs to be assessed individually. In elderly patients treated endovascularly, we observed a better treatment outcome at 3 months compared with patients treated by open surgery.

Czech name

Výsledky léčby aneuryzmatického subarachnoidálního krvácení u seniorů

Czech description

Introduction: The aim of our study is to present the treatment outcomes of patients with aneurysmal subarachnoid hemorrhage (SAH) 3 months after the attack who were treated with clipping (MS) or coiling (EV). Materials and methods: The study was based on a retrospective analysis of a database of patients with cerebral aneurysms who were treated at the University Hospital Brno between 2009 and 2019. A total of 499 patients were included in the study. Of these patients, 345 (69%) were treated with surgical MS and 154 (31%) were treated with EV. Patients were divided into 4 groups: according to the age into 0-64 years and 65+ years group, and according to the modality of treatment of aneurysm by MS or EV. We evaluated the effect of the initial Hunt-Hess (HH) score on the treatment outcome according to age and modality and also the relationship between the current age of the patient and the treatment outcome at 3 months after the SAH attack, as assessed by a modified Rankin scale (mRS), where the successful treatment outcome was mRS 0-2 (self-sufficient patient), and the effect of the initial Hunt-Hess score (HH) on the treatment outcome was based on age and modality. Results: Of the 499 patients, 345 (69%) were treated with MS and 154 (31%) with EV, and the average age of MS and EV treated patients was not statistically significantly different (P = 0.2216). In both surgically and endovascularly treated patients in all age categories; we did not observe a statistically significant difference in HH score (P = 0.1664) or in graphical severity of SAH according to the Fischer score (P = 0.5041). Satisfactory treatment outcome (mRS 0-2) at 3 months after the attack was found in 49 (52.88%) in the 65+ years group after MS and 23 (60.61%) in the 65+ years group after EV. Poor treatment outcome (mRS 3-6) at 3 months was found in 43 (47.12%) in MS treated and 15 (39.39%) in EV treated patients, which was statistically signifi cant (P = 0.0002). Satisfactory treatment outcome (mRS 0-2) at 3 months with good clinical status on admission (HH 1-2) was seen in 136 (55%) patients in the 0-64 years group after MS and 28 (33%) in the 65+ years group after MS. Poor treatment outcome (mRS 3-6) after 3 months with poor initial clinical condition (HH 3-5) had 50 (20%) patients treated with MS in the 0-64 years group and 39 (44%) treated with MS in the 65+ years group, which is statistically significant (P = 0.0001). Conclusion: Elderly (65+ years) after SAH are at a higher risk of poor neurological status 3 months after the attack compared to younger patients, especially if they are in a severe clinical condition on admission. However, a significant proportion of these patients remain in a good clinical condition after treatment of an aneurysm, so the method of treatment and extent of treatment needs to be assessed individually. In elderly patients treated endovascularly, we observed a better treatment outcome at 3 months compared with patients treated by open surgery.

Type

J_imp - Article in a specialist periodical, which is included in the Web of Science database

CEP classification

—

OECD FORD branch

30212 - Surgery

Project

—

Continuities

I - Institucionalni podpora na dlouhodoby koncepcni rozvoj vyzkumne organizace

Publication year

2023

Confidentiality

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Name of the periodical

Česká a slovenská neurologie a neurochirurgie

ISSN

1210-7859

e-ISSN

1802-4041

Volume of the periodical

86

Issue of the periodical within the volume

4

Country of publishing house

CZ - CZECH REPUBLIC

Number of pages

6

Pages from-to

256-261

UT code for WoS article

001094254600001

EID of the result in the Scopus database

2-s2.0-85172460480