title: Subarachnoid hemorrhage in elderly: advantages of the endovascular treatment.
abstract: OBJECTIVE
  Subarachnoid hemorrhage (SAH) from aneurysm rupture accounts for approximately 3% of all strokes. A significant improvement in surgery and endovascular procedures has reduced mortality and morbidity. Nowadays, endovascular treatment is a viable alternative to conservative treatment in elderly patients. We designed a retrospective observational study on all endovascular procedures carried out in our department in order to evaluate the outcome in elderly patients compared with a younger cohort.
  
  
  METHODS
  A total of 378 patients with aneurysmal SAH were treated with detachable platinum coils in our department (1994-2009). Of these, 310 patients were aged 20-69 years and 68 were aged over 70 years. Data were stratified according to Hunt-Hess (H-H) grade at admission. The mean follow up was 4.8 years. The final outcome was evaluated through the Glasgow Outcome Scale (GOS).
  
  
  RESULTS
  We observed a favorable outcome (GOS 5-4) in both groups of patients admitted with moderately good clinical conditions (H-H 1-3), with no statistically significant difference. In contrast, in the case of H-H grade at admission > 3, we observed a statistically significant poor outcome in elderly patients.
  
  
  CONCLUSIONS
  We consider the endovascular treatment as first choice for elderly patients presenting with a good H-H grade at admission. Quick functional recovery and reduced hospitalization time were observed. Unlike young patients, a chance of recovery in elderly patients with H-H 4-5 is more difficult to achieve. Therefore, a conservative approach should be considered.
authors: Division of Neurosurgery, Department of Neuroscience, University of Turin, Turin, Italy.
authors: Diego
authors: D
authors: Garbossa
authors: Pier Paolo
authors: PP
authors: Panciani
authors: Riccardo
authors: R
authors: Fornaro
authors: Emanuela
authors: E
authors: Crobeddu
authors: Nicola
authors: N
authors: Marengo
authors: Chiara
authors: C
authors: Fronda
authors: Alessandro
authors: A
authors: Ducati
authors: Mauro
authors: M
authors: Bergui
authors: Marco
authors: M
authors: Fontanella
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000150:complications* / Q000601:surgery; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D002532:Intracranial Aneurysm / Q000150:complications* / Q000601:surgery; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D055815:Young Adult