Symptomatic vasospasm in elderly patients with aneurysmal subarachnoid hemorrhage: comparison with nonelderly patients.
OBJECTIVE
To clarify the influence of age on the occurrence of symptomatic vasospasm (SVS), we retrospectively compared 34 elderly (over 70 years) and 71 nonelderly patients with aneurysmal subarachnoid hemorrhage (SAH).


METHODS
Between 2008 and 2010, at our hospital 105 patients (Hunt and Kosnik grades I-IV) underwent aneurysm surgery within 72 h of the insult. They were divided into four groups based on their age (younger/older than 70 years) and treatment (aneurysmal clipping or coiling). In all patients, we used the same protocol, which included the delivery of intrathecal urokinase and intravenous fasudil chloride; in patients with angiographic evidence of vasospasm, we also injected fasudil chloride intra-arterially.


RESULTS
Among the elderly patients, 4.3% of those treated by clipping and 9.1% of those treated by coiling experienced SVS; the comparative incidence in younger patients was 6.5% and 4.0%, respectively. The differences were not statistically significant (p = 0.40). The ratio of ventriculo peritoneal (VP) shunts was higher in the elderly patients (p = 0.00007). The incidence of favorable treatment outcomes was significantly lower in elderly patients (p = 0.00004).


CONCLUSIONS
Under our treatment protocol, patient age did not affect the incidence of SVS. Our protocol may be effective for the prevention of SVS after aneurysmal SAH regardless of patient age.
Department of Neurosurgery, Aomori Prefectural Central Hospital, Aomori, Japan.
Mizuho
M
Inoue
Tatsuya
T
Sasaki
Hiroki
H
Takazawa
Takahiro
T
Morita
Ayumi
A
Narisawa
Atsushi
A
Saito
Hiroshi
H
Midorikawa
Michiharu
M
Nishijima
D000328:Adult; D000368:Aged; D000375:Aging; D000409:Alanine / Q000031:analogs & derivatives / Q000627:therapeutic use; D017023:Coronary Angiography; D003329:Coronary Vasospasm / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000601:surgery; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage
C097293:aladotril; D014568:Urokinase-Type Plasminogen Activator; D000409:Alanine