title: Impact of ultra-early coiling on clinical outcome after aneurysmal subarachnoid hemorrhage in elderly patients.
abstract: OBJECTIVE
  The incidence of aneurysmal subarachnoid hemorrhage is increasing in the elderly as life expectancy increases. The purpose of this study was to analyze whether ultra-early coiling of ruptured intracranial aneurysms improves clinical outcomes in elderly patients.
  
  
  METHODS
  Records of patients (aged ≥ 70 years) with aneurysmal subarachnoid hemorrhage treated with endovascular coiling were retrieved. Patients were classified into two groups: group A (patients coiled within 24 hours of subarachnoid hemorrhage) and group B (patients coiled ≥24 hours after subarachnoid hemorrhage). For each group, patient demographics, World Federation of Neurological Surgeons clinical grade, Fisher computed tomographic grade, aneurysm characteristics, and clinical outcomes were recorded. Outcomes were measured using the Modified Rankin Scale at 6 months.
  
  
  RESULTS
  Fifty-six patients were coiled within 24 hours of subarachnoid hemorrhage (group A) and 40 patients at ≥24 hours after subarachnoid hemorrhage (group B). Groups A and B had similar clinical and angiographic characteristics. Clinical outcomes showed that a total of 87.5% of patient (49 of 56) in group A were independent (Modified Rankin Scale score 0-2) compared with 70.0% of patients (28 of 40) in group B (P = .034). In multivariate logistic regression analysis, ultra-early coiling (odds ratio, 3.860; 95% confidence interval, 1.125-13.249; P = .032) proved to be an independent predictor of better clinical outcome (Modified Rankin Scale score 0-2).
  
  
  CONCLUSIONS
  Ultra-early (<24 hours after subarachnoid hemorrhage) coiling of ruptured aneurysms was marginally associated with improved clinical outcomes compared to coiling at ≥24 hours in elderly patients. Larger, prospective studies are required to adequately assess outcome differences between these two groups.
authors: Department of Neurosurgery, Southern Medical University, Zhujiang Hospital, 253 Industry Road, 510282 Guangzhou, Guangdong, China.
authors: Da-Qun
authors: DQ
authors: Gu
authors: Xin
authors: X
authors: Zhang
authors: Bin
authors: B
authors: Luo
authors: Xiao-Ao
authors: XA
authors: Long
authors: Chuan-Zhi
authors: CZ
authors: Duan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001807:Blood Vessel Prosthesis / Q000706:statistics & numerical data*; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D011859:Radiography; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents / Q000706:statistics & numerical data*; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D016896:Treatment Outcome