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We evaluate the effect of introduction of endovascular treatment with Guglielmi detachable coils (GDC) on the outcome of aged patients (>=70 years old) with subarachnoid hemorrhage (SAH). Between 1990 and 2003, 92 aged patients with SAH underwent angiography as candidates for early aggressive treatment in our hospital. In 1990-96 (Group 1), treatment options were early craniotomy surgery, intensively delayed craniotomy surgery and conservative management (n=38), while GDC embolization at an acute stage was added to those 3 treatment options in 1997-2003 (Group 2, n=54). We compared clinical courses and outcomes assessed by Glasgow Outcome Scale (GOS) at discharge between the 2 groups. The percentage of the patients in whom the aneurysm was occluded at an acute stage (early-treated cases) significantly increased from 47% in Group 1 to 76% in Group 2. In the early-treated cases in Group 2, GDC embolization was chosen as the treatment option in 69% of all cases (Grade I-V) and 78% of poor-graded cases (Grade IV-V). The percentage of favorable outcomes (good recovery and moderately disabled in GOS at discharge) significantly increased from 34% in Group 1 to 63% in Group 2 for all cases, and from 53% to 78% for early-treated cases. None of the poor-graded patients had a favorable outcome in Group 1, while 24% did in Group 2. In the early-treated cases in Group 2, the percentage of favorable outcomes did not differ significantly between the aged (>=70 y) and younger patients ( The introduction of GDC embolization expanded the indication of early treatment for aged patients with poor grade and, as a consequence, improved the outcome of those patients.

Changes in Early Treatment for the Aged Patients with Severe SAH by Introduction of GDC Embolization