title: Effect of age on outcomes and practice patterns for patients with anterior communicating artery aneurysms.
abstract: BACKGROUND
  With widespread utilization of noninvasive imaging, small unruptured anterior communicating artery (AcoA) aneurysms are increasingly detected in the general population, particularly in elderly patients. We investigated the association between age and clinical characteristics and outcomes of patients with unruptured AcoA aneurysms.
  
  
  METHODS
  Between January 2008 and May 2016, information on 179 consecutive patients with unruptured AcoA aneurysms was obtained and included demographic data, aneurysm features, risk factors for formation and rupture, treatment type, complications, and follow-up information. A 2-tailed t test was used for continuous data and the chi-square test for categorical variables. Statistical significance was set at P value < 0.05.
  
  
  RESULTS
  There were 76 patients 65 and older (42.5%) and 103 younger than 65 (57.5%). Conservative management was more common in older patients (67.1% vs. 41.7%, P=0.001). Endovascular treatment was more commonly used in the older population (80% vs. 61% of the treated aneurysms in older and younger group, P=0.16). Treatment-related complications were 8% but resulted in permanent neurological deficits in one patient (1.2%). Among conservatively treated aneurysms, three (3.2%) ruptured at follow-up resulting in patient death in two cases (2.4%). All three ruptures occurred in elderly patients.
  
  
  CONCLUSIONS
  With a modern approach that emphasizes endovascular therapy, especially in older individuals, unruptured AcoA aneurysms can be treated with a very low morbidity. Among patients with small aneurysms for which treatment was not deemed indicated or necessary, the rate of rupture at follow-up was not negligible, with 5.8% of older patients experiencing bleeding from the aneurysm.
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Federico
authors.initials: F
authors.lastname: Cagnazzo
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Waleed
authors.initials: W
authors.lastname: Brinjikji
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA - lanzino.giuseppe@mayo.edu.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lanzino
mesh_terms: D000367:Age Factors; D017542:Aneurysm, Ruptured / Q000150:complications / Q000601:surgery*; D020771:Anterior Cerebral Artery / Q000601:surgery*; D002941:Circle of Willis / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods; D006801:Humans; D012189:Retrospective Studies; D012307:Risk Factors