Risk Score for Neurological Complications After Endovascular Treatment of Unruptured Intracranial Aneurysms

• Published in: Stroke (1970) Vol. 47; no. 4; pp. 971 - 978
• Main Authors: Ji, Wenjun, Liu, Aihua, Lv, Xianli, Kang, Huibin, Sun, Liqian, Li, Youxiang, Yang, Xinjian, Jiang, Chuhan, Wu, Zhongxue
• Format: Journal Article
• Language: English
• Published: United States American Heart Association, Inc 01-04-2016; Lippincott Williams & Wilkins
• Subjects: Adult; Aged; Embolization, Therapeutic - adverse effects; Endovascular Procedures - adverse effects; Female; Humans; Incidence; Intracranial Aneurysm - therapy; Male; Middle Aged; Original Contributions; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Risk Factors; Treatment Outcome; complications; intracranial aneurysm; endovascular procedures
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.115.012097

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, 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.