A Novel Risk-Predicted Nomogram for Perioperative Ischemic Complications of Endovascular Treatment Among Ruptured Anterior Communicating Artery Aneurysms

To establish and validate a risk prediction model for perioperative ischemic complication (PIC) of endovascular treatment for ruptured anterior communicating artery aneurysms (ACoAAs). The general clinical and morphologic data, operation schemes, and treatment outcomes of patients with ruptured ACoAAs treated with endovascular treatment in our center from January 2010 to January 2021 were retrospectively analyzed and assigned to primary (359 patients) and validation (67 patients) cohorts. A risk-predicted nomogram for PIC was developed through multivariate logistic regression analysis in the primary cohort. The discrimination ability, calibration accuracy, and clinical usefulness of the established PIC prediction model were evaluated and verified based on the receiver operating characteristic curves, calibration curves, and decision curve analysis in the primary and external validation cohorts, respectively. A total of 426 patients were included, 47 of whom had PIC. The multivariate logistic regression analysis showed that hypertension, Fisher grade, A1 conformation, use of stent-assisted coiling, and aneurysm orientation were independent risk factors for PIC. Then, we developed a simple and easy-to-use nomogram to predict PIC. This nomogram has a good diagnostic performance (area under the curve, 0.773; 95% confidence interval, 0.685–0.862) and calibration accuracy; we then further validated this nomogram by external validation cohort and showed an excellent diagnostic performance and calibration accuracy. Besides, the decision curve analysis confirmed the clinical usefulness of the nomogram. A history of hypertension, high preoperative Fisher grade, complete A1 conformation, use of stent-assisted coiling, and aneurysm orientation (pointing upward) are risk factors for PIC for ruptured ACoAAs. This novel nomogram might serve as a potential early warning sign of PIC for ruptured ACoAAs.