A Proposed Grading Scale Based on Radiographic Imaging for Wall Apposition to Estimate Neurologic Complications after...

The evaluation of wall apposition following flow diverter (FD) treatment remains poorly defined. This study aims to establish a radiographic grading scale for wall apposition after FD deployment and to investigate its association with FD-related neurologic complications.

This retrospective study included patients treated with the Pipeline Embolization Device (PED). A wall apposition grading scale (grades I-IV) was developed based on radiographic imaging, incorporating anatomic location and the degree of malapposition: grade I, perfect wall apposition; grade II, mild malapposition; grade III, moderate malapposition; and grade IV, severe malapposition. Cases were categorized into 2 groups: complete wall apposition (grade I) and malapposition (grades II-IV). The association between malapposition and neurologic complications was further analyzed.

A total of 197 PED cases were included. Incomplete wall apposition was observed in 29 cases (14.7%), while 168 cases (85.3%) demonstrated complete wall apposition (grade I). In the malapposition group, 13 cases (6.6%) were classified as grade II, 11 cases (5.6%) as grade III, and 5 cases (2.5%) as grade IV. FD-related perioperative and follow-up neurologic complications occurred in 10.3% and 13.8% of the malapposition group, respectively, compared with 1.8% and 1.2% in the complete wall apposition group (P < .05). Multivariate logistic regression analysis identified malapposition as an independent risk factor for FD-related neurologic complications (P < .05). The Cochran-Armitage test revealed a significant trend of increasing neurologic complications with worsening malapposition from grade II-IV (P < .05).

The proposed grading scale is a feasible and practical tool for assessing wall apposition after FD treatment. Neurologic complications are significantly more likely in cases with moderate to severe malapposition (grades III and IV).