• World Neurosurg · Jan 2024

    Multicenter Study

    Cilostazol may Improve Outcomes even in Aneurysmal Subarachnoid Hemorrhage Patients Aged 75 and Over: Multicenter Cohort Study and Propensity Score Matched Analyses.

    • Hideki Nakajima, Takeshi Okada, Fumihiro Kawakita, Hiroki Oinaka, Yume Suzuki, Mai Nampei, Yotaro Kitano, Hirofumi Nishikawa, Masashi Fujimoto, Yoichi Miura, Ryuta Yasuda, Naoki Toma, and Hidenori Suzuki.
    • Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan. Electronic address: zima0131@gmail.com.
    • World Neurosurg. 2024 Jan 1; 181: e273e290e273-e290.

    BackgroundThe opportunities to treat elderly patients with aneurysmal subarachnoid hemorrhage (aSAH) are increasing globally, but the outcome remains poor. This study seeks to investigate treatment-related factors that can modify functional outcomes in patients with aSAH aged ≥75 years.MethodsA total of 202 patients with aSAH aged ≥75 years prospectively enrolled in 9 primary stroke centers from 2013 to 2021 were retrospectively analyzed. Clinical variables including treatments for hydrocephalus, angiographic vasospasm, and delayed cerebral ischemia were compared between patients with good (modified Rankin Scale [mRS] score 0-2) and poor (mRS score 3-6) outcomes at 90 days from onset, followed by multivariate analyses to find independent outcome determinants. A modifiable treatment-related variable was evaluated after propensity score matching with adjustments for age, sex, pre-onset mRS score, aSAH severity, and treatment modality.ResultsMore than half of patients showed World Federation of Neurological Societies grades IV-V on admission. Univariate analyses showed that advanced age, worse pre-onset mRS score, more severe neurologic status on admission, higher modified Fisher grade on admission computed tomography scans, and acute and chronic hydrocephalus were associated with poor outcomes. In contrast, administration of a phosphodiesterase type III inhibitor, cilostazol, was associated with good outcomes in both univariate (P = 0.036) and multivariate analyses (adjusted odds ratio, 0.305; 95% confidence interval, 0.097-0.955; P = 0.042). Propensity score matching analyses showed that patients treated with cilostazol had better outcomes (P = 0.016) with fewer incidences of delayed cerebral infarction (P = 0.008).ConclusionsEven in patients with aSAH aged ≥75 years, cilostazol administration may lead to better outcomes by suppressing the development of delayed cerebral infarction.Copyright © 2023 Elsevier Inc. All rights reserved.

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