Meta-Analysis Conducted of Endovascular Treatment of Intracranial Aneurysms in the Elderly

July 2, 2013—In Stroke, Carmelo L. Sturiale, MD, et al published findings from a systemic review and meta-analysis of endovascular treatment of intracranial aneurysms in elderly patients (2013;44:1897–1902). The investigators were from the Mayo Clinic in Rochester, Minnesota, and led by Giuseppe Lanzino, MD. They noted in the background of the study that the use of endovascular coiling for treating ruptured and unruptured intracranial aneurysms in the elderly is increasing, so they performed a meta-analysis of the literature examining clinical and angiographic outcomes.

As summarized in Stroke, the investigators performed a comprehensive review of the literature from 1995 to 2012, reporting a series of patients aged 65 years or older with ruptured or unruptured intracranial aneurysms treated with an endovascular approach. Event rates were pooled across studies using random effects meta-analysis.

The investigators reported that a total of 21 studies reporting on 1,511 patients were included in the review. Long-term aneurysm occlusion rates were 79% (95% confidence interval [CI], 70%–85%). Perioperative stroke occurred in 4% (95% CI, 3%–6%), with similar rates between patients with ruptured (5%; 95% CI, 3%–7%) and unruptured aneurysms (4%; 95% CI, 1%–14%; P = .68). Intraprocedural rupture occurred in 1% (95% CI, 0%–3%) and 4% (95% CI, 2%–6%; P = .04) of patients with unruptured and ruptured aneurysms, respectively.

The perioperative mortality rate for patients with ruptured aneurysms was 23% (95% CI, 17%–30%) and 1% (95% CI, 0%–6%) for patients with unruptured aneurysms (P < .01). Rates of good clinical outcome at 1 year were 93% (95% CI, 88%–96%) and 66% (95% CI, 59%–72%) in patients with unruptured and ruptured aneurysms, respectively.

In their conclusion, the investigators stated that this study suggests that endovascular treatment of intracranial aneurysms in elderly patients is associated with high long-term occlusion rates. Given the morbidity and mortality associated with endovascular treatment of intracranial aneurysms in the elderly, careful patient selection, especially in the case of patients with unruptured aneurysm, is recommended.