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Endovascular Therapy for Ruptured Cerebral Aneurysms in the Elderly.

Author: Hitoshi FukudaAkira HandaMasaomi KoyanagiKazumichi YoshidaBenjamin W Y LoAll authors
Publisher: [United States?] : Oxford University Press, 2015.
Edition/Format:   Downloadable article : Document   Computer File : English
Publication:Neurosurgery
Summary:
Abstract : BACKGROUND: Endovascular therapy is favored for ruptured intracranial aneurysms in the elderly. However, poor accessibility to the aneurysm through the parent artery and use of local anesthesia in this age group may predispose to intraprocedural complications. OBJECTIVE: To evaluate whether age-related poor access to the ruptured target aneurysm and use of local anesthesia are associated with increased  Read more...
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Details

Material Type: Document
Document Type: Article, Computer File
All Authors / Contributors: Hitoshi Fukuda; Akira Handa; Masaomi Koyanagi; Kazumichi Yoshida; Benjamin W Y Lo; Sen Yamagata
ISSN:0148-396X
OCLC Number: 1016885319
Notes: In: Neurosurgery, Vol. 77, no. 4 (Oct. 2015), p.-
Description: 1 online resource

Abstract:

Abstract : BACKGROUND: Endovascular therapy is favored for ruptured intracranial aneurysms in the elderly. However, poor accessibility to the aneurysm through the parent artery and use of local anesthesia in this age group may predispose to intraprocedural complications. OBJECTIVE: To evaluate whether age-related poor access to the ruptured target aneurysm and use of local anesthesia are associated with increased incidence of procedure-related rupture during endovascular embolization. METHODS: A total of 117 patients with 117 ruptured aneurysms underwent endovascular embolization at a single institution. Correlation of increasing age with poor accessibility of the guiding catheter was analyzed. In addition, the distance from the aneurysm to the guiding catheter was investigated to identify an association with incidence of procedure-related rupture. Correlation of local anesthesia with procedure-related rupture was also evaluated in the multivariable analysis. RESULTS: Increasing age was significantly associated with poor accessibility of the guiding catheter (P = .001, Mann-Whitney U test). Procedure-related rupture occurred in 9 of 117 aneurysms (7.7%). Longer distance between distal aneurysms and low-positioned guiding catheters carried a higher risk of procedure-related rupture than a shorter distance between proximal aneurysms and high-positioned guiding catheters (odds ratio, 19.3; 95% confidence interval, 1.84-201; P = .01, multivariable analysis). Use of local anesthesia was also a significant risk factor of procedure-related rupture by multivariable analysis. CONCLUSION: Increasing age was correlated with poor accessibility of the guiding catheter in endovascular embolization of ruptured intracranial aneurysms. Distally located aneurysms treated through a low-positioned guiding catheter and use of local anesthesia increased the risk of procedure-related rupture. ABBREVIATIONS: CI, confidence interval ICA, internal carotid artery OR, odds ratio VA, vertebral artery.

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