Development and Validation of the Procedure-Related Neurologic Complications Risk Score for Elderly Patients with Ruptured Intracranial Aneurysm Undergoing Endovascular Treatment.
OBJECTIVE
Our aim was to develop and validate a procedure-related neurologic complications (PNC) risk score for individual elderly patients with ruptured intracranial aneurysms undergoing endovascular treatment (EVT).


METHODS
Preoperatively collected data, including clinical, lesion, and procedure characteristics of consecutive elderly patients (≥60 years), were used to develop a PNC risk predictive score based on the coefficients (β) of a multivariable logistic regression analysis. The PNC included intraprocedural rupture, thromboembolic events, and rebleeding within 30 days after EVT.


RESULTS
Overall, 520 elderly patients who underwent EVT were enrolled. At 30 days, the PNC rate was 13.08%. Six risk factors were independently associated with PNC and comprised the PNC score (PNC score, 0-16 points): hypertension (2 points), Hunt-Hess grade ≥4 (3 points), Fisher grade ≥3 (2 points), wide-necked aneurysm (2 points), with a bleb on the aneurysm sac (3 points), and aneurysm size (3-10 mm, 1 point; <3 mm, 4 points). The PNC score model predicted the risk of PNC at a sensitivity of 63.22% and specificity of 84.79%. Moreover, the PNC score demonstrated significant discrimination (area under curve, 0.799; P < 0.001) and calibration (Hosmer-Lemeshow test, P = 0.319). Excellent prediction, discrimination, and calibration properties were reproduced by the internal validation group with bootstrapping techniques.


CONCLUSIONS
The PNC score can be an easily applicable tool for predicting the risk of PNC for individual elderly patients with ruptured intracranial aneurysms undergoing EVT. Our study provides large case-based evidence supporting the integration of individual clinical, lesion, and procedure characteristics to predict PNC risk.
Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Guoli
G
Duan
Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Wanling
W
Wen
Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Qiao
Q
Zuo
Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Pengfei
P
Yang
Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Lei
L
Zhang
Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Bo
B
Hong
Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Yi
Y
Xu
Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China. Electronic address: liu118@vip.163.com.
Jianmin
J
Liu
Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China. Electronic address: ocinhqh@163.com.
Qinghai
Q
Huang
D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000601:surgery*; D019540:Area Under Curve; D002138:Calibration; D057510:Endovascular Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000175:diagnosis*; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment
Complication; Elderly; Endovascular treatment; Intracranial aneurysm; Risk score