title: Elderly patients with intracranial aneurysms have higher quality of life after coil embolization: a decision analysis.
abstract: OBJECTIVE
  To develop a decision analytic model to calculate outcomes after treatment of cerebral aneurysms in elderly patients. Neurosurgical clipping and endovascular coiling for both ruptured and unruptured aneurysms were compared with predicted health-related quality of life (HRQoL) after treatment.
  
  
  METHODS
  A Medline search of articles published in English between 1995 and June 2012 was performed using key words: 'intracranial aneurysms', 'treatment', or various combinations of 'elderly', 'older', or 'decade'. Reports that met inclusion criteria used either the Glasgow Outcome Score or the modified Rankin Scale for outcomes, age >69, and intracranial aneurysm that was treated by endovascular coiling or surgical clipping. Data were collected by performing a comprehensive review of published reports. Meta-analysis (inverse variance-weighted, random effects) was used to calculate pooled values for probabilities and HRQoL.
  
  
  RESULTS
  HRQoL was significantly higher for patients with coiled rather than clipped aneurysms in both ruptured (p<0.01) and unruptured (p<0.01) aneurysm groups. Periprocedural mortality rates were significantly lower among patients with a coiled, unruptured aneurysm than among patients with a clipped, unruptured aneurysm (p=0.032). Sensitivity analysis and Monte Carlo simulation for both ruptured and unruptured aneurysms showed that overall HRQoL was significantly higher in coiled than in clipped patients.
  
  
  CONCLUSIONS
  As life expectancy increases, treatment of cerebral aneurysms in the elderly becomes more important. Given the results of this decision analysis and the continuous refinement in endovascular technology, embolization should strongly be considered as a first-line treatment for cerebral aneurysms in the elderly.
authors.affiliation: Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Smith
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Sanborn
authors.affiliation: Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Lewis
authors.affiliation: Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Ryan W F
authors.initials: RW
authors.lastname: Faught
authors.affiliation: Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Venus
authors.initials: V
authors.lastname: Vakhshori
authors.affiliation: Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Sherman C
authors.initials: SC
authors.lastname: Stein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003661:Decision Support Techniques; D004621:Embolization, Therapeutic / Q000401:mortality / Q000639:trends*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008297:Male; D011788:Quality of Life; D015996:Survival Rate / Q000639:trends
keywords: Aneurysm; Coil; Economics; Hemorrhage; Subarachnoid