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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 25:596-600, April 2004
© 2004 American Society of Neuroradiology

INTERVENTIONAL

Endovascular Management of Poor-Grade Aneurysmal Subarachnoid Hemorrhage in the Geriatric Population

Rajan Jain^a, John Deveikis^a,b and Byron Gregory Thompson^b

^a Department of Radiology, University of Michigan Hospitals, Ann Arbor
^b Neurosurgery, University of Michigan Hospitals, Ann Arbor

Address reprint requests to Rajan Jain MD, Division of Neuroradiology, Department of Radiology, Henry Ford Health System, 2799 West Grand Blvd, Detroit, MI 48202

BACKGROUND AND PURPOSE: The incidence of poor-grade (Hunt and Hess grade IV and V) subarachnoid hemorrhage (SAH) is higher in elderly patients (>70 years) than in younger groups. The aim of this retrospective study was to analyze the outcome of these poor grade elderly patients after endovascular treatment.

METHODS: We retrospectively reviewed the clinical records of 27 patients older than 70 years who underwent endovascular treatment for aneurysmal SAH between January 1996 and July 2002. Thirteen patients with SAH and a poor Hunt and Hess grade at initial presentation had been treated by endovascular means. Their outcomes were assessed by the using the Glasgow Outcome Scale (GOS).

RESULTS: Two patients (15%) had a good outcome according to the GOS. Three patients (23%) were moderately disabled, two (15%) were severely disabled at the time of discharge from the hospital, and six (47%) died. Five patients (38%) developed clinical vasospasm and underwent balloon angioplasty. Three procedure-related deaths occurred (23%).

CONCLUSION: Endovascular treatment has modified the management of poor-grade SAH in elderly patients, most of whom are high-risk surgical candidates. Endovascular treatment can be administered early after the initial ictus, reducing the risk of rebleeding and providing an option to pursue aggressive triple-H therapy. Symptomatic vasospasm can also be treated by endovascular means in the initial setting.