Abstract WMP32: Endovascular Coiling Recommended for Management of Elderly Patients With Unruptured Cerebral Aneurysm Based on the Nationwide Database in Japan

Abstract

Introduction: Asymptomatic unruptured cerebral aneurysms (UCAs) are frequently discovered at brain check-up in Japan. The Japanese population has a high proportion of elderly individuals, and Japan has the highest life expectancy at birth worldwide. This aging of the population is expected to occur in other countries in the near future. Age is a significant risk factor for UCA rupture in elderly patients. This study aims to clarify the risk factors of age by comparing the outcome at discharge for UCAs between non-elderly (<65 years) and elderly (≥65 years) patients, based on the Diagnosis Procedure Combination database, the national database of in-hospital patients in Japan. Hypothesis: Effective treatment for UCA in elderly patients will be required in the future. Endovascular coiling might be a better choice for UCA in the elderly. Subjects and Methods: Outcome at discharge was investigated in two patient groups registered in the nationwide database from 2010 through 2015 in Japan. The risk factors were identified by multivariate logistic regression analysis for poor outcome using the Barthel index <90 at discharge in each group. Age, sex, location of UCA, clipping or coiling, medical history, hospital volume, and academic were evaluated as variables. Additionally, propensity score-matched analysis was conducted in both groups to compare the outcomes between clipping and coiling. Results: The risk factors for poor outcome at discharge were basilar artery aneurysm (odds ratio [OR], 1.7-2.6; 95% confidence interval [CI], 1.1-4.6), low volume hospital (OR, 2.0-2.5; 95% CI, 1.6-3.7), and diabetes mellitus (OR, 2.0-2.5; 95% CI, 1.6-3.7) in both groups, and age (OR, 1.1; 95% CI, 1.1-1.1) and clipping (OR, 1.7; 95% CI, 1.3-2.1) only in the elderly group. Hyperlipidemia was an adverse risk factor in both groups (OR, 0.6-0.7; 95% CI, 0.4-0.9). No significant difference between clipping and coiling was found in the non-elderly group (p=0.91), but better outcome by coiling was found in the elderly group (p<0.001) by propensity score-matched analysis. Conclusions: Treatment of UCA should be performed in high volume hospitals after control of diabetes mellitus. Endovascular coiling is recommended for UCA in elderly patients.