title: An outcomes-based grading scale for the evaluation of cerebral aneurysms treated with flow diversion.
abstract: OBJECTIVE
  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.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Min S
authors.initials: MS
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Marcus D
authors.initials: MD
authors.lastname: Mazur
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Karam
authors.initials: K
authors.lastname: Moon
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Nanaszko
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
authors.forename: John R W
authors.initials: JRW
authors.lastname: Kestle
authors.affiliation: Department of Radiology, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Lubdha M
authors.initials: LM
authors.lastname: Shah
authors.affiliation: Department of Radiology, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Blair
authors.initials: B
authors.lastname: Winegar
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Felipe C
authors.initials: FC
authors.lastname: Albuquerque
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Philipp
authors.initials: P
authors.lastname: Taussky
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Cameron G
authors.initials: CG
authors.lastname: McDougall
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002560:Cerebrovascular Circulation / Q000502:physiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000145:classification* / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents / Q000592:standards; D016896:Treatment Outcome; D055815:Young Adult
keywords: Aneurysm; Flow Diverter