82-year old female patient with unruptured brain aneurysm should still go for 'coil embolization'?

Hi guys, I am new here and want to get some feedback. I have an 82-year old aunt just dx’ed with a 9mm ‘saccular aneurysm’ in the left distal internal carotid artery (c1 segment, inferior direction). There are also ‘focal stenosis’ in both proximal external carotid artery. Plus, the dx includes (1) mild-to-moderate leukoaraiosis & (2) amyloid angiopathy: ‘multiple microbleeds’ in cerebellar hemispheres. That’s a lot to digest, I know! Hypertension seems to be the cause of all this: her CKD (chronic kidney disease) stage ranges from 3b to 4: GFR of 28-33.

She got the dx by chance while visiting her home country, S Korea. I thought her advanced age (82) makes her an unlikely surgery candidate but the specialist (only saw one) recommends “coil embolization”, which he says is relatively safe for the elderly in their 80s.

Do you think this makes sense? I’m not a doc but I took care of her hypertension for 15 years. My impression is, the size of her aneurysm (9mm) makes her a coil candidate. The specialist claims life expectancy is higher in S Korea and their technology is more advanced in geriatric neurosurgery. I’m not so sure about that! I’m worried about the ‘focal stenosis in both proximal ECA’ which could cause complications for coil. But also realize we may have a time bomb (9mm) and must do something other than just “watch and observe,” whether there or when she gets back to the U.S. Whaddya think? Does this look that bad? How about the location of the aneurysm: left-distal ICA c1§ inferior. If we go the coil route, then it should be done where she will be getting long-term care, right? How about the leukoaraiosis and ‘multiple microbleeds’ in cerebellar hemispheres due to amyloid angiopathy: are these common symptoms of the neurodegenerative nature of the disease, particularly for those with hypertension?

All comments welcome. Thanks for reading!


Hey George! I responded here My story: This is going to be quite a journey, I can already tell! - #2 by Moltroub. If she’s not going to stay in S. Korea, I’d get a second opinion here in the States as she may need some different therapies, but that’s me. What does she want to do?

1 Like