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.
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。