Associated Risks to the Treatment of Unruptured Intracranial Aneurysms (MARTA) Score: Development and External...

Area of Science:

• Neurosurgery
• Endovascular Surgery
• Medical Informatics

Background:

• Unruptured intracranial aneurysms (UIAs) are increasingly detected, necessitating careful management to prevent rupture.
• Current management lacks externally validated scores to predict procedural risk for treatment decisions.
• Routine clinical and aneurysmal features can potentially predict treatment complications.

Purpose of the Study:

• To develop and validate predictive scores for complications after endovascular treatment (EVT) or neurosurgical treatment (NT) of UIAs.
• To compare the performance of novel scores against existing models.

Main Methods:

• A multicenter retrospective study of 2647 patients with UIA treated via EVT or NT across 15 neurovascular centers (2014-2024).
• Predictive models (Morbidity and Mortality Associated Risk in the Treatment of UIAs - MARTA-EVT and MARTA-NT) were built using multivariable logistic regression.
• Internal validation used bootstrapping, and external validation was performed temporally and institutionally. Performance was assessed using AUROC and calibration.

Main Results:

• Procedural complications occurred in 6.3% of EVT and 12.8% of NT cases.
• MARTA-EVT (AUROC = 0.68) and MARTA-NT (AUROC = 0.65) demonstrated moderate discrimination and good calibration.
• MARTA-EVT outperformed existing models, while MARTA-NT performed similarly to SAFETEA. Predictive models are available open-source.

Conclusions:

• MARTA-EVT and MARTA-NT are validated tools for predicting procedural risks associated with UIA treatment.
• These scores can support patient counseling and clinical decision-making in neurovascular care.
• The open-source availability facilitates broader adoption and further research.