Development of the SAFETEA scores for predicting risks of complications of preventive endovascular or microneurosurgical intracranial aneurysm occlusion

• Verfasst von: Algra, Annemijn M. [VerfasserIn]
• Verfasst von: Greving, Jacoba P. [VerfasserIn]
• Verfasst von: Winkel, Jordi de [VerfasserIn]
• Verfasst von: Kurtelius, Arttu [VerfasserIn]
• Verfasst von: Laban, Kamil [VerfasserIn]
• Verfasst von: Verbaan, Dagmar [VerfasserIn]
• Verfasst von: Berg, René van den [VerfasserIn]
• Verfasst von: Vandertop, William [VerfasserIn]
• Verfasst von: Lindgren, Antti [VerfasserIn]
• Verfasst von: Krings, Timo [VerfasserIn]
• Verfasst von: Woo, Peter Y. M. [VerfasserIn]
• Verfasst von: Wong, George K. C. [VerfasserIn]
• Verfasst von: Roozenbeek, Bob [VerfasserIn]
• Verfasst von: Es, Adriaan C. G. M. van [VerfasserIn]
• Verfasst von: Dammers, Ruben [VerfasserIn]
• Verfasst von: Etminan, Nima [VerfasserIn]
• Verfasst von: Boogaarts, Hieronymus [VerfasserIn]
• Verfasst von: Doormaal, Tristan van [VerfasserIn]
• Verfasst von: Zwan, Albert van der [VerfasserIn]
• Verfasst von: Schaaf, Irene C. van der [VerfasserIn]
• Verfasst von: Rinkel, Gabriël J. E. [VerfasserIn]
• Verfasst von: Vergouwen, Mervyn D. I. [VerfasserIn]
• Titel: Development of the SAFETEA scores for predicting risks of complications of preventive endovascular or microneurosurgical intracranial aneurysm occlusion
• Verf.angabe: Annemijn M. Algra, Jacoba P. Greving, Jordi de Winkel, Arttu Kurtelius, Kamil Laban, Dagmar Verbaan, René van den Berg, William Vandertop, Antti Lindgren, Timo Krings, Peter Y.M. Woo, George K.C. Wong, Bob Roozenbeek, Adriaan C.G.M. van Es, Ruben Dammers, Nima Etminan, Hieronymus Boogaarts, Tristan van Doormaal, Albert van der Zwan, Irene C. van der Schaaf, Gabriël J.E. Rinkel, FRCPE, and Mervyn D.I. Vergouwen
• E-Jahr: 2022
• Jahr: September 2, 2022
• Umfang: 15 S.
• Fussnoten: Gesehen am 01.08.2023
• Titel Quelle: Enthalten in: Neurology
• Ort Quelle: Philadelphia, Pa. : Wolters Kluwer, 1951
• Jahr Quelle: 2022
• Band/Heft Quelle: 99(2022), 16 vom: Okt., Seite e1725-e1737
• ISSN Quelle: 1526-632X
• DOI: doi:10.1212/WNL.0000000000200978
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1853993816

Abstract

Background and Objectives Preventive unruptured intracranial aneurysm (UIA) occlusion can reduce the risk of subarachnoid hemorrhage, but both endovascular and microneurosurgical treatment carry a risk of serious complications. To improve individualized management decisions, we developed risk scores for complications of endovascular and microneurosurgical treatment based on easily retrievable patient, aneurysm, and treatment characteristics. - Methods For this multicenter cohort study, we combined individual patient data from patients with UIA aged 18 years or older undergoing preventive endovascular treatment (standard, balloon-assisted or stent-assisted coiling, Woven EndoBridge-device, or flow-diverting stent) or microneurosurgical clipping at one of the 10 participating centers from 3 continents between 2000 and 2018. The primary outcome was death from any cause or clinical deterioration from neurologic complications ≤30 days. We selected predictors based on previous knowledge about relevant risk factors and predictor performance and studied the association between predictors and complications with logistic regression. We assessed model performance with calibration plots and concordance (c) statistics. - Results Of the 1,282 included patients, 94 (7.3%) had neurologic symptoms that resolved <30 days, 140 (10.9%) had persisting neurologic symptoms, and 6 died (0.5%). At 30 days, 52 patients (4.1%) were dead or dependent. Predictors of procedural complications were size of aneurysm, aneurysm location, familial subarachnoid hemorrhage, earlier atherosclerotic disease, treatment volume, endovascular modality (for endovascular treatment) or extra aneurysm configuration factors (for microneurosurgical treatment, branching artery from aneurysm neck or unfavorable dome-to-neck ratio), and age (acronym: SAFETEA). For endovascular treatment (n = 752), the c-statistic was 0.72 (95% CI 0.67-0.77) and the absolute complication risk ranged from 3.2% (95% CI 1.6%-14.9%; ≤1 point) to 33.1% (95% CI 25.4%-41.5%; ≥6 points). For microneurosurgical treatment (n = 530), the c-statistic was 0.72 (95% CI 0.67-0.77) and the complication risk ranged from 4.9% (95% CI 1.5%-14.9%; ≤1 point) to 49.9% (95% CI 39.4%-60.6%; ≥6 points). - Discussion The SAFETEA risk scores for endovascular and microneurosurgical treatment are based on 7 easily retrievable risk factors to predict the absolute risk of procedural complications in patients with UIAs. The scores need external validation before the predicted risks can be properly used to support decision-making in clinical practice. - Classification of Evidence This study provides Class III evidence that SAFETEA scores predict the risk of procedural complications after endovascular and microneurosurgical treatment of unruptured intracranial aneurysms.