A grading scale for endovascular treatment of intracranial aneurysms

Abstract

To investigate the factors influencing the embolizing plan and result of intracranial aneurysms, and to establish a new grading scale for endovascular treatment of intracranial aneurysms. The clinical data of 156 aneurysms in 151 patients, 67 males and 84 females, aged 4-80, were prospectively collected to analyze the influences of sex, age, aneurysmal DSA manifestation (including location, shape, longest diameter, neck width and sac-neck ratio) and whether or not embolizing in acute phase on the therapeutic alternatives and immediate embolizing results. Logistic regression analyses showed that aneurysmal location (OR = 3.734, P = 0.018), neck width (OR = 16.279, P = 0.000) and sac-neck ratio (OR = 4.090, P = 0.003) were predictive factors of the therapeutic alternatives, and the longest diameter (OR = 2.725, P = 0.024), neck width (OR = 2.600, P = 0.033) and sac-neck ratio (OR = 3.144, P = 0.003) were predictive factors of the embolizing results. Aneurysmal location (0 for internal carotid system, and 1 for vertebro-basilar system), the longest diameter (0 for < 8 mm, and 1 for > or = 8 mm), neck width (0 for < 4 mm, and 1 for > or = 4 mm or without neck) and sac-neck ratio (0 for > 1.2, and 1 for < or = 1.2 or without neck) were regarded as grading items to establish the intracranial aneurysm endovascular scale (IAES), which ranked the intracranial aneurysms into four grades. The zero and first grades were ordinary aneurysms, and the second to fourth grades were complicated aneurysms. IAES helps the clinicians to determine the individualized embolizing plan and predict the embolizing effect.