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<meta name="DC.Title" content="Age-Related Trends in the Treatment and Outcomes of Ruptured Cerebral Aneurysms: A Study of the Nationwide Inpatient Sample 2001–2009" />
<meta name="DC.Identifier" content="10.3174/ajnr.A3321" />
<meta name="DC.Date" content="2013-05-01" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Patient age substantially influences treatment decisions for ruptured cerebral aneurysms. It would be useful to understand national age-related trends of treatment techniques and outcomes in patients treated for ruptured cerebral aneurysm in the United States.

MATERIALS AND METHODS: Using the US Nationwide Inpatient Sample, we evaluated trends in treatment technique (clipping versus coiling) and discharge status of patients undergoing clipping or coiling of ruptured cerebral aneurysms between 2001 and 2009. Outcomes were evaluated in relation to 4 age strata: 1) younger than 50 years of age, 2) 50–64 years of age, 3) 65–79 years of age, and 4) patients 80 years or older. We compared outcomes between treatment groups for patients treated between 2001–2004 with those treated between 2005–2009.

RESULTS: A significant increase in the proportion of patients undergoing endovascular coiling between 2001 and 2009 was noted for all age groups ( P &lt; .0001). For both clipped and coiled patients, mortality and the proportion of patients discharged to long-term facilities increased with age. Overall mortality for patients clipped and coiled decreased modestly for all age groups, and overall proportions of patients discharged home increased modestly ( P &lt; .01) for all age groups except those older than 80 years of age.

CONCLUSIONS: Between 2001 and 2009, there has been a significant increase in the proportion of patients with ruptured aneurysms undergoing endovascular coiling rather than aneurysm clipping. This increase was more pronounced in older patients. Mortality from aneurysmal subarachnoid hemorrhage decreased during the past decade, regardless of aneurysm treatment technique.

BRAT
:   Barrow Ruptured Aneurysm Trial
CCI
:   Charlson Comorbidity Index
CI
:   confidence interval
ISAT
:   International Subarachnoid Aneurysm Trial
NIS
:   Nationwide Inpatient Sample" />
<meta name="DC.Contributor" content="W. Brinjikji" />
<meta name="DC.Contributor" content="G. Lanzino" />
<meta name="DC.Contributor" content="A.A. Rabinstein" />
<meta name="DC.Contributor" content="D.F. Kallmes" />
<meta name="DC.Contributor" content="H.J. Cloft" />
<meta name="article:published_time" content="2013-05-01" />
<meta name="article:section" content="Interventional" />
<meta name="citation_title" content="Age-Related Trends in the Treatment and Outcomes of Ruptured Cerebral Aneurysms: A Study of the Nationwide Inpatient Sample 2001–2009" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Patient age substantially influences treatment decisions for ruptured cerebral aneurysms. It would be useful to understand national age-related trends of treatment techniques and outcomes in patients treated for ruptured cerebral aneurysm in the United States.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Using the US Nationwide Inpatient Sample, we evaluated trends in treatment technique (clipping versus coiling) and discharge status of patients undergoing clipping or coiling of ruptured cerebral aneurysms between 2001 and 2009. Outcomes were evaluated in relation to 4 age strata: 1) younger than 50 years of age, 2) 50–64 years of age, 3) 65–79 years of age, and 4) patients 80 years or older. We compared outcomes between treatment groups for patients treated between 2001–2004 with those treated between 2005–2009.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;A significant increase in the proportion of patients undergoing endovascular coiling between 2001 and 2009 was noted for all age groups (&lt;i&gt;P&lt;/i&gt; &amp;lt; .0001). For both clipped and coiled patients, mortality and the proportion of patients discharged to long-term facilities increased with age. Overall mortality for patients clipped and coiled decreased modestly for all age groups, and overall proportions of patients discharged home increased modestly (&lt;i&gt;P&lt;/i&gt; &amp;lt; .01) for all age groups except those older than 80 years of age.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Between 2001 and 2009, there has been a significant increase in the proportion of patients with ruptured aneurysms undergoing endovascular coiling rather than aneurysm clipping. This increase was more pronounced in older patients. Mortality from aneurysmal subarachnoid hemorrhage decreased during the past decade, regardless of aneurysm treatment technique.&lt;/p&gt;" />
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<meta name="twitter:title" content="Age-Related Trends in the Treatment and Outcomes of Ruptured Cerebral Aneurysms: A Study of the Nationwide Inpatient Sample 2001–2009" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Patient age substantially influences treatment decisions for ruptured cerebral aneurysms. It would be useful to understand national age-related trends of treatment techniques and outcomes in patients treated for ruptured cerebral aneurysm in the United States.

MATERIALS AND METHODS: Using the US Nationwide Inpatient Sample, we evaluated trends in treatment technique (clipping versus coiling) and discharge status of patients undergoing clipping or coiling of ruptured cerebral aneurysms between 2001 and 2009. Outcomes were evaluated in relation to 4 age strata: 1) younger than 50 years of age, 2) 50–64 years of age, 3) 65–79 years of age, and 4) patients 80 years or older. We compared outcomes between treatment groups for patients treated between 2001–2004 with those treated between 2005–2009.

RESULTS: A significant increase in the proportion of patients undergoing endovascular coiling between 2001 and 2009 was noted for all age groups ( P &lt; .0001). For both clipped and coiled patients, mortality and the proportion of patients discharged to long-term facilities increased with age. Overall mortality for patients clipped and coiled decreased modestly for all age groups, and overall proportions of patients discharged home increased modestly ( P &lt; .01) for all age groups except those older than 80 years of age.

CONCLUSIONS: Between 2001 and 2009, there has been a significant increase in the proportion of patients with ruptured aneurysms undergoing endovascular coiling rather than aneurysm clipping. This increase was more pronounced in older patients. Mortality from aneurysmal subarachnoid hemorrhage decreased during the past decade, regardless of aneurysm treatment technique.

BRAT
:   Barrow Ruptured Aneurysm Trial
CCI
:   Charlson Comorbidity Index
CI
:   confidence interval
ISAT
:   International Subarachnoid Aneurysm Trial
NIS
:   Nationwide Inpatient Sample" />
<meta name="og-title" property="og:title" content="Age-Related Trends in the Treatment and Outcomes of Ruptured Cerebral Aneurysms: A Study of the Nationwide Inpatient Sample 2001–2009" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/34/5/1022" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Patient age substantially influences treatment decisions for ruptured cerebral aneurysms. It would be useful to understand national age-related trends of treatment techniques and outcomes in patients treated for ruptured cerebral aneurysm in the United States.

MATERIALS AND METHODS: Using the US Nationwide Inpatient Sample, we evaluated trends in treatment technique (clipping versus coiling) and discharge status of patients undergoing clipping or coiling of ruptured cerebral aneurysms between 2001 and 2009. Outcomes were evaluated in relation to 4 age strata: 1) younger than 50 years of age, 2) 50–64 years of age, 3) 65–79 years of age, and 4) patients 80 years or older. We compared outcomes between treatment groups for patients treated between 2001–2004 with those treated between 2005–2009.

RESULTS: A significant increase in the proportion of patients undergoing endovascular coiling between 2001 and 2009 was noted for all age groups ( P &lt; .0001). For both clipped and coiled patients, mortality and the proportion of patients discharged to long-term facilities increased with age. Overall mortality for patients clipped and coiled decreased modestly for all age groups, and overall proportions of patients discharged home increased modestly ( P &lt; .01) for all age groups except those older than 80 years of age.

CONCLUSIONS: Between 2001 and 2009, there has been a significant increase in the proportion of patients with ruptured aneurysms undergoing endovascular coiling rather than aneurysm clipping. This increase was more pronounced in older patients. Mortality from aneurysmal subarachnoid hemorrhage decreased during the past decade, regardless of aneurysm treatment technique.

BRAT
:   Barrow Ruptured Aneurysm Trial
CCI
:   Charlson Comorbidity Index
CI
:   confidence interval
ISAT
:   International Subarachnoid Aneurysm Trial
NIS
:   Nationwide Inpatient Sample" />
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      <h1 class="highwire-cite-title" id="page-title">Age-Related Trends in the Treatment and Outcomes of Ruptured Cerebral Aneurysms: A Study of the Nationwide Inpatient Sample 2001–2009</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">W. Brinjikji</span>, <span class="highwire-citation-author" data-delta="1">G. Lanzino</span>, <span class="highwire-citation-author" data-delta="2">A.A. Rabinstein</span>, <span class="highwire-citation-author" data-delta="3">D.F. Kallmes</span> and <span class="highwire-citation-author" data-delta="4">H.J. Cloft</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">May 2013,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">34 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1022-1027; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A3321 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-12461--6883412744" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">W. Brinjikji </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (W.B., D.F.K., H.J.C.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=W.%2BBrinjikji%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Brinjikji%20W&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AW.%2BBrinjikji%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">G. Lanzino </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Neurosurgery (G.L.), Mayo Clinic, Rochester, Minnesota.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=G.%2BLanzino%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Lanzino%20G&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AG.%2BLanzino%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">A.A. Rabinstein </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Neurology (A.A.R.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.A.%2BRabinstein%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Rabinstein%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AA.A.%2BRabinstein%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">D.F. Kallmes </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (W.B., D.F.K., H.J.C.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.F.%2BKallmes%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kallmes%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AD.F.%2BKallmes%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">H.J. Cloft </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (W.B., D.F.K., H.J.C.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=H.J.%2BCloft%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Cloft%20H&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AH.J.%2BCloft%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" xmlns:xhtml="http://www.w3.org/1999/xhtml" class="section ref-list" id="ref-list-1"><h2>References</h2><ol class="cit-list ref-use-labels"><li><span class="ref-label">1.</span><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1. in text" id="ref-1">↵</a>

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<div class="cit ref-cit ref-journal" id="cit-34.5.1022.26"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Lanzino</span>  <span class="cit-name-given-names">G</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Kassell</span>  <span class="cit-name-given-names">NF</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Germanson</span>  <span class="cit-name-given-names">TP</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Age and outcome after aneurysmal subarachnoid hemorrhage: why do older patients fare worse?</span> <abbr class="cit-jnl-abbrev">J Neurosurg</abbr> <span class="cit-pub-date">1996</span>;<span class="cit-vol">85</span>:<span class="cit-fpage">410</span>–<span class="cit-lpage">18</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=8751625&amp;link_type=MED&amp;atom=%2Fajnr%2F34%2F5%2F1022.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a><a href="/lookup/external-ref?access_num=A1996VD34700008&amp;link_type=ISI" class="cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience"><span>Web of Science</span></a></div></div></li><li><span class="ref-label">27.</span><a class="rev-xref-ref" href="#xref-ref-27-1" title="View reference 27. in text" id="ref-27">↵</a>

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<div class="cit ref-cit ref-journal" id="cit-34.5.1022.28" data-doi="10.1161/01.STR.0000221331.01830.ce"><div class="cit-metadata"><cite><span class="cit-auth cit-collab">CARAT Investigators</span>. <span class="cit-article-title">Rates of delayed rebleeding from intracranial aneurysms are low after surgical and endovascular treatment</span>. <abbr class="cit-jnl-abbrev">Stroke</abbr> <span class="cit-pub-date">2006</span>;<span class="cit-vol">37</span>:<span class="cit-fpage">1437</span>–<span class="cit-lpage">42</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6OToic3Ryb2tlYWhhIjtzOjU6InJlc2lkIjtzOjk6IjM3LzYvMTQzNyI7czo0OiJhdG9tIjtzOjIwOiIvYWpuci8zNC81LzEwMjIuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li></ol></div></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 34</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 5 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 May 2013 </div></div>
      
      
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">W.</span> <span class="nlm-surname">Brinjikji</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Lanzino</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">A.A.</span> <span class="nlm-surname">Rabinstein</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">D.F.</span> <span class="nlm-surname">Kallmes</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">H.J.</span> <span class="nlm-surname">Cloft</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">May 2013, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">34 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1022-1027; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A3321 </span></div>
  
  
  
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      <div class="highwire-cite-title">Age-Related Trends in the Treatment and Outcomes of Ruptured Cerebral Aneurysms: A Study of the Nationwide Inpatient Sample 2001–2009</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">W.</span> <span class="nlm-surname">Brinjikji</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Lanzino</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">A.A.</span> <span class="nlm-surname">Rabinstein</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">D.F.</span> <span class="nlm-surname">Kallmes</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">H.J.</span> <span class="nlm-surname">Cloft</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">May 2013, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">34 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1022-1027; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A3321 </span></div>
  
  
  
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