Treatment and prognosis of elderly patients with unruptured cerebral aneurysms

Objective: In recent years, the number of cases of unruptured intracranial aneurysms in older patients has been increasing, but the best treatment remains a matter of debate. This study aimed to compare the treatment methods for unruptured intracranial aneurysms in patients aged 65 years and older.Methods: A retrospective review was conducted of data from unruptured intracranial aneurysms treated with surgical clipping or endovascular coiling between 2004 and 2019. Clinical and imaging information was collected. The treatment methods, procedure-related complications, and imaging and clinical results were analyzed. Data were assessed through a comparative analysis of underlying diseases (diabetes mellitus, hypertension, and hypercholesterolemia), smoking and alcohol use history, the location and size of the aneurysms for patients who received each treatment, and complications that occurred after each treatment.Results: Of 211 patients over the age of 65, 71 were treated with clipping and 140 with coiling. The complications that occurred immediately after treatment included postoperative hemorrhage (subarachnoid hemorrhage, intracerebral hemorrhage, intraventricular hemorrhage), chronic subdural hemorrhage, infection, and puncture site infection. Postoperative computed tomography images of the clipping sites had four times more opacity than those of coil embolization, but the outcomes (Glasgow outcome scores) showed no significant differences between clipping and coil embolization.Conclusion: Coil embolization and clipping are safe and effective treatment methods for unruptured intracranial aneurysms in elderly patients. Thus, the active treatment of unruptured intracranial aneurysms, which are likely to be retrofitted, should be considered.