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The impact of endovascular management on the outcome of aneurysmal subarachnoid hemorrhage in the elderly in Eastern Finland

  • Clinical Article
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Abstract

Background

The International Subarachnoid Aneurysm Trial (ISAT) concluded that “there is currently no reason to doubt that the reduction of dependent survival or death after endovascular coiling seen in all patients in the ISAT cohort should not be valid in the elderly”. We feel that this generalization requires further investigation to assess its validity.

Methods

We studied the impact of treatment era and independent risk factors for outcome in 179 consecutive elderly (≥70 years) aneurysmal subarachnoid hemorrhage (aSAH) patients admitted to Kuopio University Hospital either between 1983 and 1992 (Era I, n = 56), prior to the introduction of endovascular management, or between 1995 and 2004 (Era II, n = 123) when the endovascular treatment was established at our institute. Altogether 150 patients underwent occlusive aneurysm treatment, 47 clipping in the Era I as against 49 clipping, 49 endovascular therapy, and five combination therapy in the Era II.

Results

The 12-month survival (n = 179) did not improve from the Era I to the Era II. The proportion of good outcome (GOS IV–V) after occlusive therapy (n = 150) was equal in the Era I and Era II (n = 27/47; 57% vs. n = 56/103; 54%). In multivariate logistic regression analysis, independent predictors of poor outcome were age, poor grade (Hunt&Hess IV–V), hydrocephalus, hypertension, and intraventricular hemorrhage, but not the mode of occlusive therapy (microsurgical vs. endovascular)

Conclusion

Clinical severity of the SAH was the most significant predictor of outcome. Integration of coil treatment in clinical practice has not improved the overall outcome of aSAH in the elderly at our institute.

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Grant information/other acknowledgments

This research has been supported by grants from the Kuopio University, the Finnish Cultural Foundation and the Finnish Medical Foundation.

We gratefully acknowledge Nick Hayward, BA (Hons, Cantab) MSc, (A I Virtanen Institute, University of Kuopio, Kuopio, Finland) for his suggestions regarding the language of the manuscript.

We wish to thank Vesa Kiviniemi, MSc (IT Center, Statistical and Mathematical Services, University of Kuopio, Kuopio, Finland) for the help with the statistical analyses.

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Authors and Affiliations

  1. Department of Neurosurgery, Kuopio University Hospital, Puijonlaaksontie 2, 70211, Kuopio, Finland

    Petros Nikolaos Karamanakos, Timo Koivisto, Mohammad Khallaf, Antti Ronkainen, Mikael von und zu Fraunberg, Juha E. Jaaskelainen & Jaakko Rinne

  2. Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland

    Ritva Vanninen & Hannu Manninen

  3. Department of Intensive Care, Kuopio University Hospital, Kuopio, Finland

    Ilkka Parviainen

  4. Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland

    Juha Hernesniemi

  5. Dalcross Hospital, Australian School of Advanced Medicine, Macquarie University, Sydney, Australia

    Michael K. Morgan

Authors
  1. Petros Nikolaos Karamanakos
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  2. Timo Koivisto
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  3. Ritva Vanninen
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  4. Mohammad Khallaf
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  7. Hannu Manninen
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  8. Mikael von und zu Fraunberg
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  9. Michael K. Morgan
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  10. Juha E. Jaaskelainen
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  11. Juha Hernesniemi
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  12. Jaakko Rinne
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Corresponding author

Correspondence to Timo Koivisto.

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Karamanakos, P.N., Koivisto, T., Vanninen, R. et al. The impact of endovascular management on the outcome of aneurysmal subarachnoid hemorrhage in the elderly in Eastern Finland. Acta Neurochir 152, 1493–1502 (2010). https://doi.org/10.1007/s00701-010-0714-6

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  • DOI: https://doi.org/10.1007/s00701-010-0714-6

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