Long-term independence in older patients with aneurysmal subarachnoid hemorrhage in the Barrow Ruptured Aneurysm Trial (BRAT).

OBJECTIVE Older patients have a higher risk for poor neurological outcomes following aneurysmal subarachnoid hemorrhage (aSAH). This study compares functional independence in older versus younger patients with aSAH, and endovascular coiling to microsurgical clipping in the older cohort. METHODS Patients enrolled in the Barrow Ruptured Aneurysm Trial (BRAT) with a confirmed aSAH were analyzed. Patients were grouped by age: older (≥65 years) or younger ( 80 at the 6-year follow-up. A second analysis was performed comparing functional independence in older patients treated with endovascular coiling versus microsurgical clipping. RESULTS Of the 405 patients with aSAH enrolled in the BRAT, 77 (19%) were ages 65 years or older and 328 (81%) were less than 65 years of age. A lower percentage of older versus younger patients were functionally independent (BI >80) at 6-year follow-up (42.0% [29/69] vs 82.2% [217/264]; p<0.001). A higher percentage of younger patients (69.7% [184/264]) had good neurological outcomes (modified Rankin Scale score <3) at the 6-year follow-up compared with older patients (31.9% [22/69]) (p<0.001). A greater percentage of older patients treated with microsurgical clipping (51.0% [18/47]) versus endovascular coiling (22.7% [5/22]) had functional independence at the 6-year follow-up (p<0.04). CONCLUSION Patients 65 years or older with aSAH are at an increased risk for poor neurological outcomes compared with younger patients. Greater independence was observed in older patients after microsurgical clipping than endovascular coiling at long-term follow-up.