Risk Score for Neurological Complications After Endovascular Treatment of Unruptured Intracranial Aneurysms. Issue 4 (April 2016)

• Record Type: Journal Article
• Authors: Ji, Wenjun; Liu, Aihua; Lv, Xianli; Kang, Huibin; Sun, Liqian; Li, Youxiang; Yang, Xinjian; Jiang, Chuhan; Wu, Zhongxue
• Is Part Of: Stroke. Volume 47:Issue 4(2016)
• Publication Date: 2016-04
• Subjects: complications -- endovascular procedures -- intracranial aneurysm; Cerebrovascular disease -- Periodicals; Cerebral circulation -- Periodicals; 616.81
• DOI: 10.1161/STROKEAHA.115.012097
• Languages: English
• ISSNs: 0039-2499

Abstract

Abstract : Background and Purpose—: Procedure-related neurological complications are common after endovascular treatment of unruptured intracranial aneurysms. We aimed to develop a score to quantify individual patient risk. Methods—: We retrospectively analyzed consecutive patients who underwent endovascular treatment for unruptured intracranial aneurysms between January 2012 and September 2015. After excluding those who lost to follow-up and those with fusiform unruptured intracranial aneurysms, included patients were randomly divided into a derivation group (60%) and a validation group (40%). A neurological complication was defined as any transient or permanent increase in the modified Rankin Scale score after aneurysm embolization. A risk score for neurological complications was derived from multivariable logistic regression analyses in the derivation group and validated in the validation group. Results—: Overall, 1060 patients were included (636 in the derivation group and 424 in the validation group). The incidence of neurological complications was 5.5% (95% confidence interval, 3.8%–7.4%). A 3-point risk score (S-C-C) was derived to predict neurological complications (size [≥10 mm=1], core areas [yes=1], and cerebral ischemic comorbidity [yes=1]). The incidence of neurological complications varied from 2.2% in 0-point patients to 25.0% in 3-point patients. The score demonstrated significant discrimination ( C -statistic, 0.714; 95% confidence interval, 0.624–0.804) and calibration (McFadden R 2, 0.102) in the derivation group. Excellent prediction, discrimination, and calibration properties were reproduced in the validation group. Conclusions—: One in 20 patients will develop neurological complications after endovascular treatment of unruptured intracranial aneurysms. The S-C-C score may be useful for predicting these adverse outcomes based on variables in daily practice. Abstract : Supplemental Digital Content is available in the text.