title: Endovascular treatment of intracranial aneurysms in elderly patients: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Use of endovascular coiling for treatment of ruptured and unruptured intracranial aneurysms (IAs) in the elderly is increasing. We performed a meta-analysis of the literature examining clinical and angiographic outcomes for treatment of IAs in the elderly.
  
  
  METHODS
  We performed a comprehensive review of the literature from 1995 to 2012, reporting series of patients ≥65 years of age with ruptured or unruptured IAs treated with endovascular approach. Event rates were pooled across studies using random effects meta-analysis.
  
  
  RESULTS
  A total of 21 studies reporting on 1511 patients were included. Long-term aneurysm occlusion rates were 79% (95% confidence interval [CI], 70%-85%). Perioperative stroke occurred in 4% (95% CI, 3%-6%), with similar rates between patients with ruptured (5%; 95% CI, 3%-7%) and unruptured aneurysms (4%; 95% CI, 1%-14%; P=0.68). Intraprocedural rupture occurred in 1% (95% CI, 0%-3%) and 4% (95% CI, 2-6%; P=0.04) of patients with unruptured and ruptured aneurysms, respectively. Perioperative mortality rate for patients with ruptured aneurysms was 23% (95% CI, 17%-30%) and 1% (95% CI, 0%-6%) for patients with unruptured aneurysms (P<0.01). Rates of good clinical outcome at 1 year were 93% (95% CI, 88%-96%) and 66% (95% CI, 59%-72%) in patients with unruptured and ruptured aneurysms, respectively.
  
  
  CONCLUSIONS
  This study suggests that endovascular treatment of IAs in the elderly is associated with high long-term occlusion rates. Given the morbidity and mortality associated with endovascular treatment of IAs in the elderly, careful patient selection, especially in the case of patients with unruptured aneurysm, is recommended.
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: Carmelo L
authors.initials: CL
authors.lastname: Sturiale
authors.forename: Waleed
authors.initials: W
authors.lastname: Brinjikji
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Murad
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lanzino
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D002532:Intracranial Aneurysm / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
keywords: coiling; elderly; endovascular treatment; intracranial aneurysms; subarachnoid hemorrhage