title: Is a high initial World Federation of Neurosurgery (WFNS) grade really associated with a poor clinical outcome in elderly patients with ruptured intracranial aneurysms treated with coiling?
abstract: BACKGROUND
  Coiling of ruptured intracranial aneurysms in elderly patients remains debatable in terms of technical feasibility and clinical outcome.
  
  
  OBJECTIVE
  In this observational cohort study we aimed to assess the technical feasibility, complication profile and clinical outcomes of elderly patients with subarachnoid hemorrhage (SAH) treated with endovascular therapy.
  
  
  METHODS
  The study included 59 consecutive patients (47 women) aged ≥70 years (mean age 76 years, range 71-84) admitted to our institution with SAH from January 2002 to July 2011. The patients were treated for 66 aneurysms (regular coiling: n=62 (94%), balloon-assisted technique: n=2 (3%), stent and coil technique: n=2 (3%)). World Federation of Neurosurgery (WFNS) grade at admission was 1 in 13 patients, 2 in 23 patients, 3 in 8 patients, 4 in 11 patients and 5 in 4 patients. We analysed data by univariate and multivariate statistical analyses with an emphasis on the initial clinical situation, complications and clinical outcome.
  
  
  RESULTS
  The technical success rate was 98% with a procedure-related deficit rate of 10% and procedure-related death rate of 5%. The Glasgow Outcome Scale score at 6 months was 1 in 15 patients (25.4%), 2 in 8 patients (13.6%), 3 in 14 patients (23.7%), 4 in 11 patients (18.6%) and 5 in 11 patients (18.6%). Patients admitted with a high initial WFNS grade did not differ statistically in terms of clinical outcome. The final clinical outcome was not significantly correlated with age, initial Fisher score or procedure-related complications.
  
  
  CONCLUSIONS
  Endovascular treatment of elderly patients with ruptured cerebral aneurysms is feasible, safe and beneficial regardless of the presenting WFNS score.
authors.affiliation: Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France.
authors.forename: Christina
authors.initials: C
authors.lastname: Iosif
authors.forename: Federico
authors.initials: F
authors.lastname: Di Maria
authors.forename: Nader
authors.initials: N
authors.lastname: Sourour
authors.forename: Vincent
authors.initials: V
authors.lastname: Degos
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bonneville
authors.forename: Alessandra
authors.initials: A
authors.lastname: Biondi
authors.forename: Betty
authors.initials: B
authors.lastname: Jean
authors.forename: Chantal
authors.initials: C
authors.lastname: Colonne
authors.forename: Aurelien
authors.initials: A
authors.lastname: Nouet
authors.forename: Jacques
authors.initials: J
authors.lastname: Chiras
authors.forename: Frédéric
authors.initials: F
authors.lastname: Clarençon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods; D015331:Cohort Studies; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D012720:Severity of Illness Index; D015607:Stents; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome