A Restriction for the Surgical or Endovascular Treatment of a Ruptured Aneurysm in the Elderly

Abstract

Aneurysm treatment with clipping or coiling is indicated to prevent aneurysm re-rupture after aneurysmal subarachnoid hemorrhage (SAH). Any form of benefit of treatment requires active treatment to improve on natural history of the aneurysm. Primarily, morbidity and mortality of aneurysm treatment need to be lower than morbidity from re-rupture. For ruptured aneurysms, the risk of re-rupture within 6 months was reported at 40% for patients of all ages with a mortality of 78% [1]; and not less for elderly patients. Next to effects of initial bleeding, historical materials cite re-bleeding and surgical complications as main determinants of a bad outcome [2]. For subarachnoid hemorrhage, high age appears to increase treatment risk [3]. The highest mortality was seen in poor-grade patients over 75 who, however, were treated conservatively [4]. In addition, the expected remaining life-time for the age must be considered to assess potential benefit of preventing re-rupture, since competing risks are higher at a higher age. In contrast, several studies report favorable outcome after more aggressive management of aneurysms in an elderly population [5, 6].