A randomized controlled study assessing outcome, cognition, autonomy and quality of life in over 70-year-old patients after aneurysmal subarachnoid hemorrhage
F. Proust
(1, 2)
,
S. Bracard
(3)
,
J.-P. Lejeune
(4)
,
L. Thines
(5)
,
X. Leclerc
(4)
,
G. Penchet
(6)
,
J. Bergé
(6)
,
X. Morandi
(7, 8)
,
Jean-Yves Gauvrit
(8)
,
K. Mourier
(9)
,
Frédéric Ricolfi
(10, 9)
,
M. Lonjon
(11)
,
J. Sedat
(11)
,
B. Bataille
(12)
,
J. Droineau
(12)
,
T. Civit
(3)
,
E. Magro
(13)
,
I. Pelissou-Guyotat
(14)
,
H. Cebula
(2)
,
K. Lallouche
(2, 1)
,
P. David
(15)
,
E. Emery
(16)
,
P. Courtheoux
(16)
,
J.-R. Vignes
(6)
,
J. Bénichou
(17)
,
N. Aghakani
(15)
,
P.-H. Roche
(18)
,
E. Gay
(19)
,
P. Bessou
(2, 1)
,
J. Guabrillargues
(20)
,
B. Irthum
(20)
,
Fashe Investigators
1
Service de Neurochirurgie [CHU Rouen]
2 HUS - Les Hôpitaux Universitaires de Strasbourg
3 Service de Neurochirurgie [CHRU Nancy]
4 Département de Neurochirurgie[Lille]
5 Service de Neurochirurgie [CHRU Besançon]
6 Service de Neurochirurgie A [Bordeaux]
7 LTSI - Laboratoire Traitement du Signal et de l'Image
8 Service de neurochirurgie [Rennes] = Neurosurgery [Rennes]
9 Service de neurochirurgie [CHU Dijon]
10 CAPS - Cognition, Action, et Plasticité Sensorimotrice [Dijon - U1093]
11 Département de Neurochirurgie [Hôpital Pasteur de Nice]
12 Service de Neurochirurgie [CHU de Poitiers]
13 Service de neurochirurgie [Brest]
14 CHLS - Centre Hospitalier Lyon Sud [CHU - HCL]
15 Service de neurochirurgie [Bicêtre]
16 Service de Neurochirurgie [CHU Caen]
17 Unité de Biostatistiques [CHU Rouen]
18 Neurologie, maladies neuro-musculaires [Hôpital de la Timone - APHM]
19 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
20 Service de Neurochirurgie [CHU Clermont-Ferrand]
2 HUS - Les Hôpitaux Universitaires de Strasbourg
3 Service de Neurochirurgie [CHRU Nancy]
4 Département de Neurochirurgie[Lille]
5 Service de Neurochirurgie [CHRU Besançon]
6 Service de Neurochirurgie A [Bordeaux]
7 LTSI - Laboratoire Traitement du Signal et de l'Image
8 Service de neurochirurgie [Rennes] = Neurosurgery [Rennes]
9 Service de neurochirurgie [CHU Dijon]
10 CAPS - Cognition, Action, et Plasticité Sensorimotrice [Dijon - U1093]
11 Département de Neurochirurgie [Hôpital Pasteur de Nice]
12 Service de Neurochirurgie [CHU de Poitiers]
13 Service de neurochirurgie [Brest]
14 CHLS - Centre Hospitalier Lyon Sud [CHU - HCL]
15 Service de neurochirurgie [Bicêtre]
16 Service de Neurochirurgie [CHU Caen]
17 Unité de Biostatistiques [CHU Rouen]
18 Neurologie, maladies neuro-musculaires [Hôpital de la Timone - APHM]
19 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
20 Service de Neurochirurgie [CHU Clermont-Ferrand]
F. Proust
- Fonction : Auteur correspondant
Jean-Yves Gauvrit
- Fonction : Auteur
- PersonId : 181610
- IdHAL : jean-yves-gauvrit
- ORCID : 0000-0002-8057-6004
- IdRef : 073678015
Frédéric Ricolfi
- Fonction : Auteur
- PersonId : 998805
P.-H. Roche
- Fonction : Auteur
- PersonId : 793560
- ORCID : 0000-0002-2397-4700
Fashe Investigators
- Fonction : Auteur
Résumé
BACKGROUND: Current aging of the population with good physiological status and the increasing incidence of subarachnoid hemorrhage (SAH) in elderly patients has enhanced the benefit of treatment in terms of independence and long-term quality of life (QoL). METHODS: From November 1, 2008 to October 30, 2012, 351 patients aged 70 years or older with aneurysmal SAH underwent adapted treatment: endovascular coiling (EV) for 228 (65%) patients, microsurgical clipping (MS) for 75 (29.3%) or conservative treatment for 48 (13.7%). Forty-one of these were randomized to EV (n=20) or to MS (n=21). The objectives were to determine the proportion of patients with modified Rankin Scale score≤2 (independence) at 1 year, and, secondarily, to compare cognitive function on the Mini-Mental State Examination (MMSE), autonomy on the Activities of Daily Living Index (ADLI) and Instrumental Activities of Daily Living scale (IADL), and QoL, in the prospective and randomized arms, at 1 year. RESULTS: At 1 year, with 1 loss to follow-up in the EV arm, 11 patients (55%) were independent after EV occlusion and 8 (38.1%) after MS exclusion, without significant difference (P=0.29). Mortality was higher after MS during the first 2 postoperative months, and thereafter the difference between MS and EV ceased to be significant. Cognitive function and autonomy scores were similar in both arms. CONCLUSION: In elderly patients treated for aneurysmal SAH, approximately 50% were independent at 1 year, with conserved cognition and autonomy. EV and MS are valid procedures in this population, with similar results at 1 year in terms of independence, cognition, autonomy, and QoL.