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. 2022 Aug 24:13:923645.
doi: 10.3389/fneur.2022.923645. eCollection 2022.

Independent predictors and risk score for intraprocedural rupture during endovascular treatment of small ruptured intracranial aneurysms (<5 mm)

Fei Peng  1   2 , Xin Feng  3   4 , Xiaoxin He  1   2 , Hao Niu  1   2 , Hong Zhang  5 , Xin Tong  1   2 , Baorui Zhang  1   2 , Jiaxiang Xia  1   2 , Xuge Chen  1   2 , Boya Xu  1   2 , Peng Qi  6   7 , Jun Lu  6   7 , Daming Wang  6   7 , Aihua Liu  1   2   3   4
Affiliations

Independent predictors and risk score for intraprocedural rupture during endovascular treatment of small ruptured intracranial aneurysms (<5 mm)

Fei Peng et al. Front Neurol. .

Abstract

Background and purpose: Intraprocedural rupture (IPR) is a devastating complication of endovascular treatment (EVT). Small-sized and ruptured aneurysms are independent predictors of IPR, which presents a technical challenge during EVT. We aimed to develop a score to quantify the individual patient risk of IPR in the EVT of small (<5 mm) ruptured aneurysms (SRAs).

Methods: A retrospective review was conducted to interrogate databases prospectively maintained at two academic institutions in China from January 2009 to October 2016. We collected intraoperative angiograms and medical records to identify independent predictors of IPR using univariate and multivariable analyses. A risk score for IPR was derived using multivariable logistic regression analyses.

Results: Of the 290 enrolled patients, IPR occurred in 16 patients (5.5%). The univariate analysis showed that the rate of IPR was significantly higher in patients having aneurysms with a small basal outpouching (SBO), in patients having aneurysms concomitant with adjacent moderate atherosclerotic stenosis (ACAMAS), and in former or current smokers. Multivariate analyses showed that SBO [odds ratio (OR): 3.573; 95% confidence interval (CI): 1.078-11.840; p = 0.037], vascular eloquence (VE; OR: 3.780; 95% CI: 1.080-13.224; p = 0.037), and ACAMAS (OR: 6.086; 95% CI: 1.768-20.955; p = 0.004) were significantly and independently associated with IPR. A three-point risk score (S-V-A) was derived to predict IPR [SBO (yes = 1), VE (yes = 1), and ACAMAS (yes = 1)].

Conclusions: Intraprocedural rupture occurred in 5.5% of the patients during EVT of SRA. SBO, VE, and ACAMAS were independent risk factors of IPR in the EVT of SRA. Based on these variables, the S-V-A score may be useful in predicting IPR daily, but more confirmation studies are required.

Keywords: endovascular treatment; intracranial aneurysms; intraprocedural rupture; risk score; small.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The patient inclusion flowchart. AVM, arteriovenous malformation; AVF, arteriovenous fistula; IPR, intraprocedural rupture.
Figure 2
Figure 2
Receiver operating characteristic (ROC) curves for the IPR score. The AUC value was 0.716 (95% CI: 0.58–0.86) for this model. AUC, area under the curve; CI, confidence interval. IPR, intraprocedural rupture.
Figure 3
Figure 3
Rates of IPR by the clinical score for patients with SRAs. The predicted rates of patients with SRAs with a score of 0, 1, 2, and 3 have IPR rates of 2.1, 7.4, 23.0, and 53.0%, respectively. The observed rates of patients with SRAs with a score of 0, 1, 2, and 3 have IPR rates of 2.4, 6.7, 21.1, and 100%, respectively. IPR, intraprocedural rupture; SRAs, small ruptured aneurysms.
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