J Cerebrovasc Endovasc Neurosurg.  2020 Dec;22(4):237-244. 10.7461/jcen.2020.E2020.08.002.

Endovascular coil embolization for unruptured intracranial aneurysms in patients over 80 years of age

• Lee SW
• Kwon HJ
• Jeong EO
• Koh HS
• Kim KH
• Choi SW
• Kim SH
• Youm JY

• KMID: 2511037
• DOI: http://doi.org/10.7461/jcen.2020.E2020.08.002

Abstract

Objective
As the average life span in modern society continues to increase, much interest is focused on high-risk procedures in elderly patients, including major surgical operations. We investigated the results of endovascular coiling of unruptured intracranial aneurysms (UIA) in patients over 80 years of age.
Methods
We retrospectively analyzed 39 patients aged over 80 years who underwent coil embolization for UIA between April 2007 and April 2019 at our hospital.
Results
Complete occlusion on digital subtraction angiography (DSA) immediately after surgery was performed in 44 (84.6%) of 52 cases of cerebral aneurysms. Four patients (7.7%) had residual aneurysmal necks, and four (7.7%) had contrast flow in the aneurysmal sac. Follow-up magnetic resonance angiography (mean: 8.2 months) was performed in 37 aneurysms in 24 patients. There was evidence of blood flow in the neck in seven cases (18.9%) and aneurysm in two cases (5.4%). Follow-up DSA (mean: 20.5 months) was performed in 14 aneurysms in 11 patients, and 11 aneurysms (78.6%) had complete occlusion, 1 aneurysm (7.1%) had an aneurysmal neck, and 2 aneurysms (14.3%) had contrast filling into the aneurysmal sac. Coil embolization procedure-related complications occurred in 3 patients (7.7%). Cerebral infarction occurred in 1 (2.6%), arterial dissection in 1 (2.6%), and hypoesthesia in 1 (2.6%).
Conclusions
Active treatment of UIA in elderly patients over 80 years of age through endovascular coil embolization can be considered.

Keyword

Elderly; Endovascular procedures; Intracranial aneurysm; Coil

Figure

• 

  Fig. 1. (A) Preoperative left internal carotid artery angiogram showing left internal carotid artery aneurysm and mild stenosis proximal to the aneurysm (arrow). (B) Postoperative left internal carotid artery angiogram showing left internal carotid artery aneurysm filled with coils (arrow). (C) Left internal carotid artery angiogram on post-embolization day 8 showing thrombus at the site of stent deployment (arrow) and occluded internal carotid artery by thrombus. (D) Left internal carotid artery angiogram after chemical thrombolysis showing a thrombus (arrow) and partially recanalized internal carotid artery.

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  Fig. 2. (A) The left common carotid artery angiogram showing severely tortuous proximal left common carotid artery with abnormal contrast stasis and vessel wall irregularities suggesting dissection (arrows). (B) Preoperative left common carotid artery angiogram showing left supraclinoid and paraclinoid internal carotid artery aneurysms and left middle cerebral artery bifurcation aneurysm (arrows). (C) Postoperative left internal carotid artery angiogram showing left supraclinoid and paraclinoid internal carotid artery aneurysms and left middle cerebral artery bifurcation aneurysm filled with coils (arrows). (D) Left common carotid artery angiogram after stent insertion in the dissected segment showing tolerable flow in the proximal left common carotid artery (arrows).

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