Unruptured Intracranial Aneurysms in Elderly Patients: Results of Surgical and Endovascular Treatment

Background: Management of unruptured intracranial aneurysms (UIA) in elderly patients is controversial, taking into consideration their limited life-expectancy and existing comorbidities. With advances in endovascular techniques, we decided to evaluate treatment results in this population and to assess results in surgically and endovascularly treated cases. Methods: Thirty six elderly patients, aged ≥ 70, with the total of 39 aneurysms, were treated. The possibility of endovascular treatment was considered as the first option and surgical treatment as the second method of intervention. Results: No patient died and no patient became bedridden after the procedures. In surgical group (14 UIA), deterioration was observed in five cases at the time of discharge, but persisted in only two cases at follow-up. In endovascular group (25 UIA), deterioration was observed in one case at the time of discharge and persisted at follow-up. Endovascular techniques included coils placement alone in nine (36%) procedures, coiling with stent placement in five (20%) procedures and stent placement alone in eleven (44%) procedures. Follow-up DSA revealed no treatment effect in three patients after stent placement alone (12% of endovascularly treated aneurysms). Of these, two patients were successfully retreated with second flow-diverting stent placement and one patient refused retreatment. Conclusion: Treatment of elderly patients with UIA is relatively safe and effective. Worse short-term and long-term outcomes were observed among the operated compared to embolized patients. In patients treated with stent placement alone, treatment failure and the need for the next stage of embolization in some cases should be taken into account.