title: Cerebrovascular diseases in the elderly: the challenge of multiple aneurysms.
abstract: OBJECTIVE
  The worldwide population aging and the nowadays medical advances impose to consider new management guidelines for elderly. Aim of this study was to assess the best treatment in elderly with multiple intracranial aneurysms (MIA).
  
  
  METHODS
  From 1994 to 2011, we admitted 1462 patients with ruptured cerebral aneurysm. Among those aged ≥65 years, 43 had MIA (15% of elderly). Size and aneurysm location, timing and type of treatment were analyzed. Patients were thus stratified according to Hunt-Hess grade on admission and evaluated at 6 months using the Glasgow Outcome Scale (GOS).
  
  
  RESULTS
  We had 87 aneurysms in the final series. Three patients died because of the impossibility to treat the ruptured aneurysm. No new bleeding from untreated aneurysms was observed; no retreatment after previous coiling was performed.
  
  
  CONCLUSIONS
  MIA lead to significantly poorer outcomes, especially in elderly, because of their general clinical condition, presence of risk factors and lower capacity of reaction to stressful events. In patients without large hematomas, coiling of the ruptured aneurysm represents the procedure with high effectiveness. The clinical conditions on admission represent the most important factor for the treatment results. To reduce the treatment-related risks we do recommend a conservative approach for the unruptured aneurysms.
authors: Department of Neuroscience, Division of Neurosurgery, 1University of Torino, 2University of Brescia, Torino and Brescia, Italy.
authors: Emanuela
authors: E
authors: Crobeddu
authors: Pier Paolo
authors: PP
authors: Panciani
authors: Diego
authors: D
authors: Garbossa
authors: Giulia
authors: G
authors: Pilloni
authors: Riccardo
authors: R
authors: Fornaro
authors: Gabriele
authors: G
authors: Ronchetti
authors: Giannantonio
authors: G
authors: Spena
authors: Fulvio
authors: F
authors: Tartara
authors: Alessandro
authors: A
authors: Ducati
authors: Marco
authors: M
authors: Fontanella
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors
keywords: cerebrovascular diseases; coiling; elderly; endovasular treatment; multiple cerebral aneurysms; subarachnoid hemorrhage