• Christopher S Ogilvy, Michelle H Chua, Matthew R Fusco, Christoph J Griessenauer, Mark R Harrigan, Ashish Sonig, Adnan H Siddiqui, Elad I Levy, Kenneth Snyder, Michael Avery, Alim Mitha, Jorma Shores, Brian L Hoh, and Ajith J Thomas.
• *Neurosurgical Service, Beth Israel Deaconess Medical Center, Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts; ‡Harvard Medical School, Boston, Massachusetts; §Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama; ¶Departments of Neurosurgery and Radiology and Toshiba Stroke Research Center, University at Buffalo, State University of New York, Buffalo, New York; ‖Division of Neurosurgery, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada; #University of Florida College of Medicine, Gainesville, Florida; **Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida.
• Neurosurgery. 2015 Aug 1;77(2):168-73; discussion 173-4.

BackgroundWith increasing use of endovascular techniques in the treatment of ruptured and unruptured aneurysms, the issue of obliteration efficacy has become increasingly important. We have previously reported the Aneurysm Recanalization Stratification Scale, which uses accessible predictors including aneurysm-specific factors (size, rupture, and intraluminal thrombosis) and treatment-related features (treatment modality and immediate angiographic result) to predict retreatment risk after endovascular therapy.ObjectiveTo assess the external validity of the Aneurysm Recanalization Stratification Scale.MethodsExternal validity was assessed in independent cohorts from 4 centers in the United States and Canada where endovascular and open neurovascular procedures are performed, and in a multicenter cohort of 1543 patients. Probability of retreatment stratified by risk score was derived for each center and the combined multicenter cohort.ResultsDespite moderate variability in retreatment rate among centers (29.5%, 9.9%, 9.6%, 26.3%, 19.7%, and 18.3%), the Aneurysm Recanalization Stratification Scale demonstrated good predictive value with C-statistics of 0.799, 0.943, 0.780, 0.695, 0.755, and 0.719 for each center and the combined cohort, respectively. Probability of retreatment stratified by risk score for the combined cohort is as follows: -2, 4.9%; -1, 5.7%; 0, 5.8%; 1, 13.1%; 2, 19.2%; 3, 34.9%; 4, 32.7%; 5, 73.2%; 6, 89.5%; and 7, 100.0%.ConclusionSurgical decision-making and patient-centered informed consent require comprehensive and accessible information on treatment efficacy. The Aneurysm Recanalization Stratification Scale is a valid prognostic index. This is the first comprehensive model that has been developed to quantitatively predict retreatment risk following endovascular therapy.

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