Endovascular treatment for aneurysmal subarachnoid hemorrhage in the ninth decade of life and beyond

OBJECTIVE: As the population ages, clinicians will be faced with difficult decisions regarding treatment of elderly patients presenting with aneurysmal subarachnoid hemorrhage (aSAH). Previous data have led to continued pessimism by some clinicians treating elderly and very elderly patients presenting with aSAH. The aim of this study was to present our experience in the very elderly treated with endovascular coiling after presentation with aSAH. METHODS: Retrospective review of all patients 80 years of age or older presenting with aSAH who underwent coil embolization. Primary outcomes of interest were functional outcome, as assessed by the Glasgow Outcome Scale score, and inhospital mortality. RESULTS: During the study period, 16 patients aged 80 years or older presenting with aSAH underwent coil embolization; nine (56%) had a poor outcome at the 6 month follow-up while seven (44%) had a good outcome. The inhospital mortality rate was 50%. Of those patients alive at discharge, seven out of eight (88%) patients had a good outcome. Variables associated with poor outcome included higher Hunt and Hess score (p=0.010), use of balloon assistance/remodeling (p=0.025), and presence of coronary artery disease (p=0.006). CONCLUSIONS: Not surprisingly, we found that very elderly patients presenting with aSAH have a high inhospital mortality rate. However, those patients who survive to discharge have a surprisingly robust chance at good functional recovery when treated with coil embolization. We believe these results support offering endovascular coil embolization, when feasible, to very elderly patients presenting with aSAH.