Skip to main content
SpringerLink
Log in

Comparison of treatment outcomes and complications of coil embolization in elderly and very elderly patients with cerebral aneurysms: a propensity score matching analysis

Acta Neurochirurgica volume 165, pages 3361–3369 (2023)Cite this article

Abstract

Purpose

This single center study aims to compare the treatment outcomes and procedure-related complications of coil embolization in elderly patients (60–79 years) and very elderly patients (aged 80 years or older) with cerebral aneurysms.

Methods

Data was collected from 504 elderly patients aged 60 years or older who underwent coil embolization for intracranial aneurysms from 2018 to 2021. The study evaluated patient-related and anatomical factors and assessed various outcomes, comparing results between groups using statistical analysis and propensity score matching.

Results

A total of 503 cerebral aneurysms were analyzed from individuals aged 60–79 years (n = 472) and those aged 80 years or older (n = 31). The majority of the aneurysms were unruptured with an average size of 3.5 mm in height and 3.4 mm in width. The patients were compared using 1:1 propensity score matching, and no significant differences were found in factors other than age and aortic elongation. Logistic analysis revealed that being over 80 years old and having a severe aortic arch elongation were identified as risk factors for procedure-related events in both total and unruptured cases.

Conclusions

The study compared coil embolization treatment for cerebral aneurysms in patients aged 60–79 and over 80, finding no significant difference in treatment outcomes except for procedure-related events. Procedure-related events were associated with severe aortic arch elongation and being over 80 years old. Coil embolization can be considered safe and effective for patients over 80, but further trials are needed for accurate conclusions.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

Data Availability

Data is available upon reasonable request.

References

  1. Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL et al (2019) Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation 139:e56–e528. https://doi.org/10.1161/cir.0000000000000659

    Article  PubMed  Google Scholar 

  2. Bradac GB, Bergui M, Fontanella M (2005) Endovascular treatment of cerebral aneurysms in elderly patients. Neuroradiology 47:938–941. https://doi.org/10.1007/s00234-005-1444-y

    Article  CAS  PubMed  Google Scholar 

  3. Brinjikji W, Rabinstein AA, Lanzino G, Kallmes DF, Cloft HJ (2011) Effect of age on outcomes of treatment of unruptured cerebral aneurysms: a study of the National Inpatient Sample 2001-2008. Stroke 42:1320–1324. https://doi.org/10.1161/strokeaha.110.607986

    Article  PubMed  Google Scholar 

  4. Burzotta F, Nerla R, Pirozzolo G, Aurigemma C, Niccoli G, Leone AM, Saffioti S, Crea F, Trani C (2015) Clinical and procedural impact of aortic arch anatomic variants in carotid stenting procedures. Catheter Cardiovasc Interv 86:480–489. https://doi.org/10.1002/ccd.25947

    Article  PubMed  Google Scholar 

  5. Cai Y, Spelle L, Wang H, Piotin M, Mounayer C, Vanzin JR, Moret J (2005) Endovascular treatment of intracranial aneurysms in the elderly: single-center experience in 63 consecutive patients. Neurosurgery 57:1096–1102; discussion 1096-1102. https://doi.org/10.1227/01.neu.0000185583.25420.df

    Article  PubMed  Google Scholar 

  6. Chang FC, Tummala RP, Jahromi BS, Samuelson RM, Siddiqui AH, Levy EI, Hopkins LN (2009) Use of the 8 French Simmons-2 guide catheter for carotid artery stent placement in patients with difficult aortic arch anatomy. J Neurosurg 110:437–441. https://doi.org/10.3171/2008.7.17627

    Article  PubMed  Google Scholar 

  7. Eckard DA, Krehbiel KA, Johnson PL, Raveill TG, Eckard VR (2003) Stiff guide technique: technical report and illustrative case. AJNR Am J Neuroradiol 24:275–278

    PubMed  PubMed Central  Google Scholar 

  8. Gizewski ER, Göricke S, Wolf A, Schoch B, Stolke D, Forsting M, Wanke I (2008) Endovascular treatment of intracranial aneurysms in patients 65 years or older: clinical outcomes. AJNR Am J Neuroradiol 29:1575–1580. https://doi.org/10.3174/ajnr.A1165

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Gonzalez NR, Dusick JR, Duckwiler G, Tateshima S, Jahan R, Martin NA, Viñuela F (2010) Endovascular coiling of intracranial aneurysms in elderly patients: report of 205 treated aneurysms. Neurosurgery 66:714–720; discussion 720-711. https://doi.org/10.1227/01.Neu.0000367451.59090.D7

    Article  PubMed  Google Scholar 

  10. Huang H, O'Neill AH, Chandra RV, Lai LT (2020) Asymptomatic intracranial aneurysms in the elderly: long-term clinical and radiologic follow-up of 193 consecutive patients. World Neurosurg 133:e600–e608. https://doi.org/10.1016/j.wneu.2019.09.103

    Article  PubMed  Google Scholar 

  11. Hwang SK, Hwang G, Oh CW, Jin SC, Park H, Bang JS, Kwon OK (2011) Endovascular treatment for unruptured intracranial aneurysms in elderly patients: single-center report. AJNR Am J Neuroradiol 32:1087–1090. https://doi.org/10.3174/ajnr.A2458

    Article  PubMed  PubMed Central  Google Scholar 

  12. Inagawa T (2010) Size of ruptured intracranial saccular aneurysms in patients in Izumo City, Japan. World Neurosurg 73:84–92; discussion e11. https://doi.org/10.1016/j.surneu.2009.07.001

    Article  PubMed  Google Scholar 

  13. Johansson M, Norbäck O, Gál G, Cesarini KG, Tovi M, Solander S, Contant CF, Ronne-Engström E, Enblad P (2004) Clinical outcome after endovascular coil embolization in elderly patients with subarachnoid hemorrhage. Neuroradiology 46:385–391. https://doi.org/10.1007/s00234-004-1170-x

    Article  CAS  PubMed  Google Scholar 

  14. Khosla A, Brinjikji W, Cloft H, Lanzino G, Kallmes DF (2012) Age-related complications following endovascular treatment of unruptured intracranial aneurysms. AJNR Am J Neuroradiol 33:953–957. https://doi.org/10.3174/ajnr.A2881

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Kim SU, Sung JH, Lee DH, Yi HJ, Lee HJ, Yang JH, Lee IW (2019) Feasibility of using neck extension to overcome a difficult aortic arch and gain access to the carotid artery. World Neurosurg 125:e110–e116. https://doi.org/10.1016/j.wneu.2018.12.216

    Article  PubMed  Google Scholar 

  16. Lakatta EG, Levy D (2003) Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: part I: aging arteries: a “set up” for vascular disease. Circulation 107:139–146. https://doi.org/10.1161/01.cir.0000048892.83521.58

    Article  PubMed  Google Scholar 

  17. Lam RC, Lin SC, DeRubertis B, Hynecek R, Kent KC, Faries PL (2007) The impact of increasing age on anatomic factors affecting carotid angioplasty and stenting. J Vasc Surg 45:875–880. https://doi.org/10.1016/j.jvs.2006.12.059

    Article  PubMed  Google Scholar 

  18. Lee SH, Lee SU, Kwon OK, Bang JS, Ban SP, Kim T, Kim YD, Byoun HS, Oh CW (2021) Clinical outcomes of clipping and coiling in elderly patients with unruptured cerebral aneurysms: a national cohort study in Korea. J Korean Med Sci 36:e178. https://doi.org/10.3346/jkms.2021.36.e178

    Article  PubMed  PubMed Central  Google Scholar 

  19. Lee SU, Kim T, Kwon OK, Bang JS, Ban SP, Byoun HS, Oh CW (2020) Trends in the incidence and treatment of cerebrovascular diseases in Korea : part I. Intracranial Aneurysm, Intracerebral Hemorrhage, and Arteriovenous Malformation. J Korean Neurosurg Soc 63:56–68. https://doi.org/10.3340/jkns.2018.0179

    Article  PubMed  Google Scholar 

  20. Lee TH, Choi CH, Park KP, Sung SM, Lee SW, Lee BH, Kim DH, Kim HJ, Kim CW, Kim S (2005) Techniques for intracranial stent navigation in patients with tortuous vessels. AJNR Am J Neuroradiol 26:1375–1380

    PubMed  PubMed Central  Google Scholar 

  21. Lin SC, Trocciola SM, Rhee J, Dayal R, Chaer R, Morrissey NJ, Mureebe L, McKinsey JF, Kent KC, Faries PL (2005) Analysis of anatomic factors and age in patients undergoing carotid angioplasty and stenting. Ann Vasc Surg 19:798–804. https://doi.org/10.1007/s10016-005-8045-4

    Article  PubMed  Google Scholar 

  22. Lubicz B, Leclerc X, Gauvrit JY, Lejeune JP, Pruvo JP (2004) Endovascular treatment of ruptured intracranial aneurysms in elderly people. AJNR Am J Neuroradiol 25:592–595

    PubMed  PubMed Central  Google Scholar 

  23. Luo CB, Teng MM, Chang FC, Chang CY (2007) Endovascular embolization of ruptured cerebral aneurysms in patients older than 70 years. J Clin Neurosci 14:127–132. https://doi.org/10.1016/j.jocn.2006.05.018

    Article  PubMed  Google Scholar 

  24. Mokin M, Snyder KV, Levy EI, Hopkins LN, Siddiqui AH (2015) Direct carotid artery puncture access for endovascular treatment of acute ischemic stroke: technical aspects, advantages, and limitations. J Neurointerv Surg 7:108–113. https://doi.org/10.1136/neurintsurg-2013-011007

    Article  PubMed  Google Scholar 

  25. Oishi H, Yamamoto M, Nonaka S, Shimizu T, Yoshida K, Mitsuhashi T, Arai H (2015) Treatment results of endosaccular coil embolization of asymptomatic unruptured intracranial aneurysms in elderly patients. J Neurointerv Surg 7:660–665. https://doi.org/10.1136/neurintsurg-2014-011305

    Article  PubMed  Google Scholar 

  26. O'Rourke MF (2007) Arterial aging: pathophysiological principles. Vasc Med 12:329–341. https://doi.org/10.1177/1358863x07083392

    Article  PubMed  Google Scholar 

  27. Peeling L, Fiorella D (2014) Balloon-assisted guide catheter positioning to overcome extreme cervical carotid tortuosity: technique and case experience. J Neurointerv Surg 6:129–133. https://doi.org/10.1136/neurintsurg-2013-010655

    Article  PubMed  Google Scholar 

  28. Ruzsa Z, Nemes B, Pintér L, Berta B, Tóth K, Teleki B, Nardai S, Jambrik Z, Szabó G, Kolvenbach R, Hüttl K, Merkely B (2014) A randomised comparison of transradial and transfemoral approach for carotid artery stenting: RADCAR (RADial access for CARotid artery stenting) study. EuroIntervention 10:381–391. https://doi.org/10.4244/eijv10i3a64

    Article  PubMed  Google Scholar 

  29. Sedat J, Dib M, Rasendrarijao D, Fontaine D, Lonjon M, Paquis P (2005) Ruptured intracranial aneurysms in the elderly: epidemiology, diagnosis, and management. Neurocrit Care 2:119–123. https://doi.org/10.1385/ncc:2:2:119

    Article  PubMed  Google Scholar 

  30. Statistics Korea (2022) Population projections for Korea : 2020~2070 year (Based on the 2020 Population census).

  31. Stiefel MF, Park MS, McDougall CG, Albuquerque FC (2010) Endovascular treatment of unruptured intracranial aneurysms in the elderly: analysis of procedure related complications. J Neurointerv Surg 2:11–15. https://doi.org/10.1136/jnis.2009.001685

    Article  CAS  PubMed  Google Scholar 

  32. Sturiale CL, Brinjikji W, Murad MH, Lanzino G (2013) Endovascular treatment of intracranial aneurysms in elderly patients: a systematic review and meta-analysis. Stroke 44:1897–1902. https://doi.org/10.1161/STROKEAHA.113.001524

    Article  PubMed  Google Scholar 

  33. Takata M, Fukuda H, Kinosada M, Miyake K, Murao K (2017) Use of simple neck extension to improve guiding catheter accessibility in tortuous cervical internal carotid artery for endovascular embolization of intracranial aneurysm: a technical note. World Neurosurg 105:529–533. https://doi.org/10.1016/j.wneu.2017.06.023

    Article  PubMed  Google Scholar 

  34. Texakalidis P, Sweid A, Mouchtouris N, Peterson EC, Sioka C, Rangel-Castilla L, Reavey-Cantwell J, Jabbour P (2019) Aneurysm formation, growth, and rupture: the biology and physics of cerebral aneurysms. World Neurosurg 130:277–284. https://doi.org/10.1016/j.wneu.2019.07.093

    Article  PubMed  Google Scholar 

  35. Thompson BG, Brown RD Jr, Amin-Hanjani S, Broderick JP, Cockroft KM, Connolly ES Jr, Duckwiler GR, Harris CC, Howard VJ, Johnston SC, Meyers PM, Molyneux A, Ogilvy CS, Ringer AJ, Torner J (2015) Guidelines for the management of patients with unruptured intracranial aneurysms: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 46:2368–2400. https://doi.org/10.1161/str.0000000000000070

    Article  PubMed  Google Scholar 

  36. Ungvari Z, Kaley G, de Cabo R, Sonntag WE, Csiszar A (2010) Mechanisms of vascular aging: new perspectives. J Gerontol A Biol Sci Med Sci 65:1028–1041. https://doi.org/10.1093/gerona/glq113

    Article  PubMed  Google Scholar 

  37. United Nations (2022) World Population Prospects 2022: Summary of Results (trans: Department of Economic and Social Affairs, Division P). United Nations. UN DESA/POP/2022/TR/NO. 3.38.

  38. Vernooij MW, Ikram MA, Tanghe HL, Vincent AJ, Hofman A, Krestin GP, Niessen WJ, Breteler MM, van der Lugt A (2007) Incidental findings on brain MRI in the general population. N Engl J Med 357:1821–1828. https://doi.org/10.1056/NEJMoa070972

    Article  CAS  PubMed  Google Scholar 

  39. White JB, Kallmes DF (2008) Utility of the “buddy” wire in intracranial procedures. Neuroradiology 50:185–187. https://doi.org/10.1007/s00234-007-0313-2

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of emergency medicine, Kyung Hee University Hospital at Gangdong, Seoul, South Korea

    Han-Zo Choi

  2. Department of Neurosurgery, Myong-Ji St. Mary’s Hospital, 156, Dorimro, Youngdungpo-gu, Seoul, 07417, Republic of Korea

    Sang-Uk Kim, Joon Huh, Hyun-Goo Lee, Mi-Kyung Kim, Dal-Soo Kim & Choon-Woong Huh

Authors
  1. Han-Zo Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sang-Uk Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joon Huh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hyun-Goo Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mi-Kyung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dal-Soo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Choon-Woong Huh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sang-Uk Kim.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

ESM 1

(DOCX 50 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Choi, HZ., Kim, SU., Huh, J. et al. Comparison of treatment outcomes and complications of coil embolization in elderly and very elderly patients with cerebral aneurysms: a propensity score matching analysis. Acta Neurochir 165, 3361–3369 (2023). https://doi.org/10.1007/s00701-023-05793-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-023-05793-2

Keywords

search

Navigation