Outcomes of Atherosclerotic Cerebral Aneurysm Surgery in Advanced Age Patients

Background: The advanced age of patients usually increases the incidence of atherosclerotic cerebral aneurysm. The risk of treating this type of aneurysm by surgical clipping is development of a thromboembolic event. We would like to know the exact rate of ischemic event and the risk factors associated with embolic stroke by treatment of this aneurysm in elderly patients. Methods: This is a retrospective cohort study in patients older than 70 years who were diagnosed as unruptured atherosclerotic cerebral aneurysm and underwent microsurgical clipping between January 2012 and August 2014. We compared the ischemic events and factors associated with embolic stroke with a younger group of patients (70 years old). The endpoint was the incidence of cerebral infarction evaluated by brain imaging and discharge modified Rankin Scale (mRS) score. A statistical analysis of the factors associated with embolic stroke was done by Fisher’s exact tests in each group. Results: Among 30 atherosclerotic cerebral aneurysms of older group of patient, only 2 patients (6.7%) were associated with postoperative cerebral infarction. There were no factors associated with ischemic outcome. In the younger age group, only 1 patient (1.4%) developed cerebral infarction and the number of clips was associated with ischemic outcome (P = 0.01). Conclusions: The older patients had an increasing trend of cerebral infarction after surgery compared with the younger patients. No independent risk factors were associated with cerebral infarction after atherosclerotic cerebral aneurysm surgery in the greater than 70-year-old group.