Depending on the site of the rupture, either endovascular coiling or neurosurgical clipping may be an appropriate choice for treatment of a ruptured subarachnoid aneurysm in the elderly, according to researchers.

Depending on the site of the rupture, either endovascular coiling or neurosurgical clipping may be an appropriate choice for treatment of a ruptured subarachnoid aneurysm in the elderly, according to Swedish and UK researchers.

As lead investigator Dr. Matt Ryttlefors told Reuters Health, "the main finding is that in elderly patients with subarachnoid hemorrhage in good neurological condition, the location of the ruptured aneurysm has implications for the choice of method to treat the aneurysm."

In the October issue of Stroke, Dr. Ryttlefors of Uppsala University Hospital and colleagues report that they studied 278 patients at least 65 years old. They were randomized to endovascular coiling or neurosurgical clipping.

At one year, 60.1 per cent of the endovascular coiling group had achieved independent survival compared with 56.1 per cent of the neurosurgical clipping group. This difference was not significant.

However, 72.0 per cent of endovascular coiling patients with internal carotid and posterior communicating artery aneurysms were independent compared with 52.0 per cent of such neurosurgical clipping patients.

In contrast, 86.7 per cent of neurosurgical clipping patients with middle cerebral artery aneurysms were independent compared with 45.5 per cent of those who had endovascular coiling.

Despite the influence of location, overall, there was a trend towards a better outcome with endovascular coiling. "Patients who were treated with endovascular coil," Dr. Ryttlefors concluded, "had a shorter length of stay in hospital and fewer complications, such as epilepsy and infections, than the neurosurgically treated."

Stroke 2008;39:2720-2726