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Risk Stratification and Surveillance After Endovascular Coiling for Intracranial Aneurysms: Development of a

Junghyun Park1, Jeffrey Steinberg2

  • 1Department of Neurosurgery, College of Medicine, Kosin University Gospel Hospital, Busan, Republic of Korea.

World Neurosurgery
|February 15, 2026
PubMed
Summary

A new RACE scale helps predict early aneurysm recurrence after endovascular coiling. This tool stratifies patients into low, moderate, and high-risk groups to guide post-treatment surveillance effectively.

Keywords:
Endovascular coilingFollow-upIntracranial aneurysmRecurrenceRisk stratificationSurveillance

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Area of Science:

  • Neurosurgery
  • Interventional Radiology
  • Vascular Neurology

Background:

  • Aneurysm recurrence after endovascular coiling is a significant clinical concern.
  • Lack of standardized risk stratification complicates post-treatment surveillance intensity.
  • Predicting early recurrence is crucial for optimizing patient follow-up.

Purpose of the Study:

  • To identify predictors of early intracranial aneurysm recurrence post-endovascular coiling.
  • To develop a simplified risk stratification tool for guiding post-coiling surveillance.

Main Methods:

  • Retrospective analysis of 432 intracranial aneurysms treated with endovascular coiling.
  • Evaluation of clinical and angiographic variables including aneurysm size, morphology, rupture status, and occlusion grade (RROC).
  • Cox proportional-hazards modeling and ROC analysis to assess time-to-recurrence and model performance.

Main Results:

  • Early recurrence occurred in 5.8% of aneurysms during a mean 14-month follow-up.
  • Independent predictors of recurrence included large aneurysm size (≥10 mm), residual sac (RROC III), and bifurcation morphology.
  • The developed RACE scale effectively stratified aneurysms into low (1-2%), moderate (6-8%), and high-risk (15-20%) recurrence groups with good discrimination (AUC 0.86).

Conclusions:

  • The RACE scale offers a practical framework for early risk stratification of aneurysm recurrence after endovascular coiling.
  • This tool can aid in tailoring post-coiling imaging surveillance strategies.
  • Particular benefit is expected for identifying and managing high-risk aneurysms.