Increased Age Associated with Reduced Likelihood of Recurrence After Coiling of Ruptured Aneurysms

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The effect of patient age on the likelihood of recurrence of ruptured aneurysms after endovascular coil embolization is not well understood. Our aim was to compare the incidence of aneurysmal recurrence after coiling between young and old patients. We performed a retrospective cohort study on patients presenting to our institution with a ruptured intracranial aneurysm treated with endovascular coiling. Aneurysm recurrence was defined as a Modified Raymond Roy Classification (MRRC) grade of 3A or 3B performed on first follow-up angiography. Patients were dichotomized into young and old patient groups, with patients 65 years and older categorized as older adults. The relationship between patient age and the likelihood of aneurysm recurrence was then investigated using multivariate logistic regression analysis. There were 156 patients who met our inclusion criteria for analysis, 37 (23.7%) of whom were greater than or equal to 65 years of age. Elderly patients were less likely to experience aneurysm recurrence (27.0% vs. 42.9%, respectively; P= 0.085) or to undergo aneurysm retreatment (18.9% vs. 37.0%, respectively; P= 0.041). On multivariate analysis, after adjusting for smoking status, aneurysmal size, coil-embolization ratio, and MRRC grade at time of treatment, elderly age was independently associated with a reduced risk of aneurysm recurrence (odds ratio, 0.33; 95% confidence interval, 0.11-0.92; P= 0.034). Our results suggest that elderly age may confer a reduced risk of aneurysmal recurrence after endovascular coiling, providing further evidence that coiling should be considered a first-line therapy in elderly patients with a ruptured aneurysm.