Abstract：
BACKGROUND: Treatment outcomes of octogenarians with aneurysmal subarachnoid hemorrhage (aSAH) are often considered poor. With ongoing advancements and experience in endovascular technology, we sought to evaluate the outcomes of octogenarians treated for aSAH in the second post-International Subarachnoid Aneurysm Trial (ISAT)/Barrow Ruptured Aneurysm Trial (BRAT) decade.
METHODS: A single-center database of aSAH was reviewed to identify patients aged 80 years or above undergoing aneurysm treatment. Mortality and favorable neurologic outcome (defined as modified Rankin Scale score <3) were assessed among the series and compared across several subgroups.
RESULTS: Octogenarian patients constituted 6% of the aSAH cohort (38 of 619) over the reviewed period. Twenty-one percent were high grade (Hunt-Hess grade 4-5). Endovascular treatment was the first-line modality in 90% of patients. During a median follow-up of 17 months, the overall mortality was 39%. Higher mortality was associated with poor Hunt-Hess grade (100% for grade 5, 47% for III-IV, 13% for 1-2, P = 0.004) and non-independent baseline function status (100% mortality for non-independent vs. 28% for independent group, P = 0.002). At last follow-up, 53% of patients achieved a favorable neurologic outcome. The stratified rate was 80% in Hunt-Hess grade I-II and over 60% in patients with premorbid independent function status or less than 5 frailty components (P ≤ 0.02 vs. poorer counterparts).
CONCLUSIONS: Neurologic outcomes of octogenarian patients with aSAH are improving in the second post-trial decade, particularly given the preponderance of endovascular treatment. Baseline functional status and comorbidities of octogenarians should be considered in addition to the Hunt-Hess grade in prognostication.
METHODS: A single-center database of aSAH was reviewed to identify patients aged 80 years or above undergoing aneurysm treatment. Mortality and favorable neurologic outcome (defined as modified Rankin Scale score <3) were assessed among the series and compared across several subgroups.
RESULTS: Octogenarian patients constituted 6% of the aSAH cohort (38 of 619) over the reviewed period. Twenty-one percent were high grade (Hunt-Hess grade 4-5). Endovascular treatment was the first-line modality in 90% of patients. During a median follow-up of 17 months, the overall mortality was 39%. Higher mortality was associated with poor Hunt-Hess grade (100% for grade 5, 47% for III-IV, 13% for 1-2, P = 0.004) and non-independent baseline function status (100% mortality for non-independent vs. 28% for independent group, P = 0.002). At last follow-up, 53% of patients achieved a favorable neurologic outcome. The stratified rate was 80% in Hunt-Hess grade I-II and over 60% in patients with premorbid independent function status or less than 5 frailty components (P ≤ 0.02 vs. poorer counterparts).
CONCLUSIONS: Neurologic outcomes of octogenarian patients with aSAH are improving in the second post-trial decade, particularly given the preponderance of endovascular treatment. Baseline functional status and comorbidities of octogenarians should be considered in addition to the Hunt-Hess grade in prognostication.
摘要：
背景：患有动脉瘤性蛛网膜下腔出血（aSAH）的八十岁老人的治疗结果，通常被认为是穷人。随着血管内技术的不断进步和经验，我们试图评估在ISAT/BRAT试验后第二个10年接受aSAH治疗的八十岁老人的结局.
方法：回顾了aSAH的单中心数据库，以确定80岁或以上接受动脉瘤治疗的患者。在系列中评估死亡率和良好的神经系统结局（定义为mRS<3），并在几个亚组之间进行比较。
结果：在回顾期间，八十岁患者占aSAH队列的6%（38/619）。21％的人是高年级（Hunt-HessIV-V）。血管内治疗是90％患者的一线治疗方式。在17个月的中位随访中，总死亡率为39%.较高的死亡率与不良的亨特-赫斯等级相关(V级为100%，III-IV为47%，I-II为13%，P=0.004）和非独立基线功能状态（非独立与100％死亡率28%为独立组，P=0.002)。在最后的随访中，53%的患者获得了良好的神经系统转归。Hunt-HessI-II级患者的分层率为80％，在病前独立功能状态或小于5个衰弱成分的患者中，分层率为60％以上（P≤0.02vs.较差的同行)。
结论：八十岁的aSAH患者的神经系统结局在第二个试验后十年有所改善，特别是考虑到血管内治疗的优势。除了预测Hunt-Hess等级外，还应考虑八十岁老人的基线功能状态和合并症。
方法：回顾了aSAH的单中心数据库，以确定80岁或以上接受动脉瘤治疗的患者。在系列中评估死亡率和良好的神经系统结局（定义为mRS<3），并在几个亚组之间进行比较。
结果：在回顾期间，八十岁患者占aSAH队列的6%（38/619）。21％的人是高年级（Hunt-HessIV-V）。血管内治疗是90％患者的一线治疗方式。在17个月的中位随访中，总死亡率为39%.较高的死亡率与不良的亨特-赫斯等级相关(V级为100%，III-IV为47%，I-II为13%，P=0.004）和非独立基线功能状态（非独立与100％死亡率28%为独立组，P=0.002)。在最后的随访中，53%的患者获得了良好的神经系统转归。Hunt-HessI-II级患者的分层率为80％，在病前独立功能状态或小于5个衰弱成分的患者中，分层率为60％以上（P≤0.02vs.较差的同行)。
结论：八十岁的aSAH患者的神经系统结局在第二个试验后十年有所改善，特别是考虑到血管内治疗的优势。除了预测Hunt-Hess等级外，还应考虑八十岁老人的基线功能状态和合并症。
