title: Long-term excess mortality of patients with treated and untreated unruptured intracranial aneurysms.
abstract: OBJECTIVE
  Subarachnoid haemorrhage (SAH) patients have an excess mortality proportion in long-term outcome studies because of the high rate of cerebrovascular and cardiovascular deaths. The aim of the present study was to assess the excess long-term mortality among patients with unruptured aneurysms with no previous SAH and to compare excess mortality after coiling, clipping and without treatment.
  
  
  METHODS
  Between 1989 and 1999, a total of 1294 patients with intracranial aneurysms were admitted to our hospital. Of these, 1154 had previous SAH and were excluded leaving 140 patients with 178 intracranial unruptured aneurysms as the study population. The patients were followed up until death or by the end of April 2011. Causes of death were determined. Relative survival ratios (RSRs) were calculated and compared with the matched general population.
  
  
  RESULTS
  Mean follow-up time was 13 years (range 1-19). During the follow-up period, 36% of patients died. Death was caused by cerebrovascular event in half of the cases. There were 12% excess mortality at 15 years in men and 35% excess mortality in women compared with general population. Excess mortality among women over 50 years was significantly higher than that among men (p=0.018).
  
  
  CONCLUSIONS
  Patients with untreated unruptured aneurysms have 50% excess long-term mortality compared with general population. Men with treated unruptured aneurysms have a survival proportion comparable with matched general population. Women, instead, have 28% excess mortality after surgical treatment and 23% excess mortality after endovascular treatment of unruptured aneurysms.
authors: Department of Neurosurgery, Tampere University Hospital, PO Box 2000, Tampere FIN-33521, Finland. liisa.pyysalo@uta.fi
authors: Liisa
authors: L
authors: Pyysalo
authors: Tapio
authors: T
authors: Luostarinen
authors: Leo
authors: L
authors: Keski-Nisula
authors: Juha
authors: J
authors: Öhman
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000401:mortality; D004621:Embolization, Therapeutic / Q000401:mortality; D057510:Endovascular Procedures / Q000401:mortality; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D002532:Intracranial Aneurysm / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000401:mortality*; D012306:Risk; D012737:Sex Factors; D013345:Subarachnoid Hemorrhage / Q000401:mortality; D016019:Survival Analysis; D055815:Young Adult
keywords: Cerebrovascular; Stroke