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Peer-reviewedCC BY 4.0Frontiers in Neurology

Quantifying procedural burden during stent-assisted coil embolization for unruptured intracranial aneurysms: development of the aneurysm endovascular procedural complexity score and internal validation of a multivariable complication model

  • Yuxiang Huang1
  • E Zhu2
  • Zijun Huang1
  • Yuehang Ouyang1
  • Jian Luo1
  • Liuqing Liu2
  • Xiaosong Huang2
  1. 1College of Clinical Medicine, Hunan University of Chinese Medicine
  2. 2Department of Neurology, The Second People’s Hospital of Hunan Province (Brain Hospital of Hunan Province)
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Abstract

Procedural complexity during stent-assisted coil embolization (SAC) is commonly assessed subjectively and is not adequately represented by conventional pre-procedural risk factors. This single-center retrospective cohort study developed the Aneurysm Endovascular Procedural Complexity Score (AEPCS) and internally validated a multivariable complication model incorporating the score in 484 patients with unruptured intracranial aneurysms treated with SAC between January 2018 and December 2025. The AEPCS integrated procedure duration, contrast volume, and the system-reported procedure-level radiation index (mGy) after natural-log transformation, Z -standardization, equal-weight averaging, and final standardization. The primary outcome was a composite of symptomatic cerebral infarction, symptomatic intracranial hemorrhage, or all-cause death within 28 days. Major periprocedural complications occurred in 71 patients (14.7%). After adjustment for age, sex, hypertension, diabetes mellitus, posterior-circulation location, aneurysm diameter, neck width, and multiple aneurysms, each 1-standard-deviation increase in the AEPCS was associated with higher odds of a major complication [adjusted odds ratio (OR), 5.25; 95% confidence interval (CI), 3.51–7.86; p < 0.001]. The AEPCS showed an area under the receiver operating characteristic curve (AUC) of 0.846 (95% CI, 0.797–0.890); its discrimination was significantly better than that of procedure duration alone but did not differ significantly from the radiation index or contrast volume. In a sensitivity analysis that reincluded 33 patients with definite intraprocedural complications requiring rescue treatment, the association remained materially unchanged (adjusted OR, 5.31; 95% CI, 3.55–7.93; p < 0.001), with an AUC of 0.842. The multivariable model had an apparent AUC of 0.853 and an optimism-corrected AUC of 0.834 (95% CI, 0.795–0.890) after 2,000 full-pipeline bootstrap resamples. The AEPCS should therefore be regarded primarily as a standardized composite measure of cumulative procedural burden rather than an outcome-optimized prediction score. External validation is required before clinical implementation.

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Cite

BibTeXRIS
BibTeX
@article{huang2026quantifying,
  title = {{Quantifying procedural burden during stent-assisted coil embolization for unruptured intracranial aneurysms: development of the aneurysm endovascular procedural complexity score and internal validation of a multivariable complication model}},
  author = {Yuxiang Huang and E Zhu and Zijun Huang and Yuehang Ouyang and Jian Luo and Liuqing Liu and Xiaosong Huang},
  journal = {Frontiers in Neurology},
  year = {2026},
  month = oct,
  doi = {10.3389/fneur.2026.1956688},
  url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1956688/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Quantifying procedural burden during stent-assisted coil embolization for unruptured intracranial aneurysms: development of the aneurysm endovascular procedural complexity score and internal validation of a multivariable complication model
AU  - Yuxiang Huang
AU  - E Zhu
AU  - Zijun Huang
AU  - Yuehang Ouyang
AU  - Jian Luo
AU  - Liuqing Liu
AU  - Xiaosong Huang
PY  - 2026
DA  - 2026/10/30
JO  - Frontiers in Neurology
DO  - 10.3389/fneur.2026.1956688
UR  - https://www.frontiersin.org/articles/10.3389/fneur.2026.1956688/full
AB  - Procedural complexity during stent-assisted coil embolization (SAC) is commonly assessed subjectively and is not adequately represented by conventional pre-procedural risk factors. This single-center retrospective cohort study developed the Aneurysm Endovascular Procedural Complexity Score (AEPCS) and internally validated a multivariable complication model incorporating the score in 484 patients with unruptured intracranial aneurysms treated with SAC between January 2018 and December 2025. The AEPCS integrated procedure duration, contrast volume, and the system-reported procedure-level radiation index (mGy) after natural-log transformation, Z -standardization, equal-weight averaging, and final standardization. The primary outcome was a composite of symptomatic cerebral infarction, symptomatic intracranial hemorrhage, or all-cause death within 28 days. Major periprocedural complications occurred in 71 patients (14.7%). After adjustment for age, sex, hypertension, diabetes mellitus, posterior-circulation location, aneurysm diameter, neck width, and multiple aneurysms, each 1-standard-deviation increase in the AEPCS was associated with higher odds of a major complication [adjusted odds ratio (OR), 5.25; 95% confidence interval (CI), 3.51–7.86; p < 0.001]. The AEPCS showed an area under the receiver operating characteristic curve (AUC) of 0.846 (95% CI, 0.797–0.890); its discrimination was significantly better than that of procedure duration alone but did not differ significantly from the radiation index or contrast volume. In a sensitivity analysis that reincluded 33 patients with definite intraprocedural complications requiring rescue treatment, the association remained materially unchanged (adjusted OR, 5.31; 95% CI, 3.55–7.93; p < 0.001), with an AUC of 0.842. The multivariable model had an apparent AUC of 0.853 and an optimism-corrected AUC of 0.834 (95% CI, 0.795–0.890) after 2,000 full-pipeline bootstrap resamples. The AEPCS should therefore be regarded primarily as a standardized composite measure of cumulative procedural burden rather than an outcome-optimized prediction score. External validation is required before clinical implementation.
SN  - 1664-2295
ER  -