An outcomes-based grading scale for the evaluation of cerebral aneurysms treated with flow diversion.

Abstract

OBJECT:

Despite the popularity of flow-diverting stents for the treatment of cerebral aneurysms, there is no widely accepted scale for the characterization of results. We present an outcomes-based grading scale that considers factors related to failure of flow diversion.

METHODS:

The grading scale was developed using the results from consecutive patients at two institutions who were treated with flow diversion for a cerebral aneurysm. The initial treatment results were graded on patient, aneurysm, and treatment characteristics. A 6-point grading scale was developed based on these data.

RESULTS:

One hundred and seventy-one patients were included in the patient cohort. When compared by multivariate analysis with patients without residuals, patients with aneurysm residuals were found to be older (age ≥60 years, p=0.01, OR 1.17, 95% CI 1.03 to 1.33), to have larger aneurysms (size ≥15 mm, p<0.01, OR 1.38, 95% CI 1.17 to 1.62), to have aneurysms with associated side branches (p=0.02, OR 1.17, 95% CI 1.03 to 1.33), and to have a post-treatment Raymond score of 2 or 3 (p=0.01, OR 1.28, 95% CI 1.06 to 1.56). Using the Raymond score (1-3) as the foundation for the grading scale, additional points (0 or 1) were given for the other three identified factors, creating a 6-point scale. We found that patients with residual aneurysms had statistically higher final tabulated scores (p<0.01).

CONCLUSIONS:

We propose a novel straightforward outcomes-based scale to characterize results after flow diversion treatment of cerebral aneurysms. This scale may provide the basis for the common reporting of results in future studies.

• Authors: Min S Park, Marcus D Mazur, Karam Moon, Michael J Nanaszko, John R W Kestle, Lubdha M Shah, Blair Winegar, Felipe C Albuquerque, Philipp Taussky, Cameron G McDougall
• Journal: Journal of neurointerventional surgery (J Neurointerv Surg) Vol. 9 Issue 11 Pg. 1060-1063 (Nov 2017) ISSN: 1759-8486 [Electronic] England
• PMID: 27760832 (Publication Type: Evaluation Study, Journal Article)
• Copyright: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Cerebrovascular Circulation (physiology)
• Cohort Studies
• Female
• Humans
• Intracranial Aneurysm (classification, diagnostic imaging, surgery)
• Male
• Middle Aged
• Retrospective Studies
• Stents (standards)
• Treatment Outcome
• Young Adult