• Felipe Ramirez-Velandia, Alejandro Enriquez-Marulanda, Jean Filo, Thomas B Fodor, Daniel Sconzo, Emmanuel Mensah, Michael Young, Sandeep Muram, Justin H Granstein, Max Shutran, Philipp Taussky, and Christopher S Ogilvy.
• Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
• World Neurosurg. 2024 Oct 1; 190: e579e587e579-e587.

BackgroundFactors impacting the rate of aneurysm occlusion after flow diversion (FD) have been well described in the literature. In this article, we sought to evaluate those variables to develop and validate a scoring system predicting aneurysm incomplete occlusion after FD.MethodsRetrospective review of patients with intracranial aneurysms treated with FD at a single institution between March 2013 and March 2023. Multivariable logistic regression model was developed using factors associated with aneurysm incomplete occlusion. The ABC scoring system consisted of: Age (<60 years old: 0, 60-69 years: 1, 70-79: 2, and ≥80: 3), Branch coming out of the aneurysm dome/neck (yes: 2, no: 0), and Cigarette smoking history (never smoker: 1, current or past smoker: 0). The scoring system performance was evaluated with receiver operating characteristic curve and calculating the area under the curve.ResultsA total of 449 patients with 563 aneurysms treated in 482 procedures were evaluated. Most cases were females (81.7%) with a median age of 59 years old. At a median follow-up of 13.2 months, 84.0% of aneurysms were completely or near-complete occluded. The scoring system had an area under the curve of 0.71. A value ≥ 2, reached a sensitivity of 74.4%, a specificity of 60.9%, a likelihood ratio+ of 1.90, and proved to be reliable in predicting the risk of incomplete occlusion (odds ratio = 4.53; 95% confidence interval: 2.73-7.54; P < 0.001).ConclusionsThe proposed ABC scoring system can be used to evaluate the risk of aneurysm incomplete occlusion after treatment with FD, identifying patients who would benefit from adjunctive coiling or alternative treatment modalities.Copyright © 2024 Elsevier Inc. All rights reserved.

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