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Intracerebral aneurysms: a review with special attention to geriatric aspects
Thomas Vogel1, René Verreault, Jean-François Turcotte
1Centre de Gérontologie, Hôpital de la Robertsau, Strasbourg, France. vogelthomas@wanadoo.fr
Insights
Intracranial aneurysm (ICA) rupture is serious, but older adults are increasingly candidates for treatment. A geriatric assessment approach helps tailor optimal treatment strategies for elderly patients with ICAs.
Area of Science:
- Geriatric Medicine
- Neurology
- Vascular Surgery
Background:
- Ruptured intracranial aneurysms (ICAs) cause significant morbidity and mortality.
- Historically, elderly patients were often excluded from active treatment due to age alone.
- Less-invasive diagnostic and treatment techniques are evolving for ICAs.
Purpose of the Study:
- To reconsider the exclusion of elderly patients from active ICA treatment.
- To review the epidemiological, physiopathological, clinical, and therapeutic aspects of ICAs in older adults.
- To highlight the utility of a comprehensive geriatric assessment for optimizing treatment strategies in the elderly.
Main Methods:
- Review of geriatric features related to intracranial aneurysms.
- Analysis of epidemiological data in older populations.
- Evaluation of physiopathological, clinical, and therapeutic aspects specific to elderly patients.
Main Results:
- Chronological age should no longer be the sole basis for excluding older patients from ICA treatment.
- The heterogeneity of the elderly population necessitates individualized treatment approaches.
- Comprehensive geriatric assessment is crucial for determining optimal management strategies.
Conclusions:
- A shift from age-based exclusion to a patient-centered, geriatric assessment approach is warranted for ICAs.
- Less-invasive techniques improve treatment feasibility in older adults.
- Multidisciplinary evaluation ensures personalized and effective management of intracranial aneurysms in the elderly.
Abstract:
Rupture of an intracranial aneurysm (ICA) remains a devastating complication associated with a high degree of morbidity and mortality. In the past 2 decades, older people were often excluded from active treatment on the unique basis of their chronological age. Recent developments of less-invasive techniques for the diagnosis and treatment of ruptured and unruptured ICAs suggest that this fatalistic attitude toward older patients should be reconsidered. Furthermore, taking into account the heterogeneity of the elderly population, the use of a comprehensive geriatric assessment approach, based on a multidisciplinary evaluation, appears particularly helpful in proposing the optimal treatment strategy for each older patient. This article reviews the geriatric features of epidemiological, physiopathological, as well as clinical and therapeutic aspects of ruptured and unruptured ICAs.