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Updated: May 22, 2026
Optical Coherence Tomography Based Biomechanical Fluid-Structure Interaction Analysis of Coronary Atherosclerosis Progression
Published on: January 15, 2022
Development and validation of the pre-scope score for predicting incomplete occlusion after pipeline embolization
Hongyun Zhang1, Xinjian Yang2, Hongqi Zhang3
1Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan University People's Hospital, Zhengzhou 450003, Henan Province, China; Department of Neurology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan, China.
Background:
Approximately 25% of aneurysms treated with Pipeline remain incompletely occluded at 6 months. This study aimed to develop and externally validate a novel preoperative scoring system to predict the risk of incomplete occlusion.
Methods:
This retrospective multicenter study developed a model using data from 588 patients (659 aneurysms) (PLUS study, 2014-2019). An external validation cohort consisted of 189 patients with 235 aneurysms from a single participating center (2020-2022). Feature selection was performed using the least absolute shrinkage and selection operator (LASSO) regression, followed by multivariable logistic regression modeling. Model performance was assessed by the Area Under the Curve (AUC), calibration, and bootstrap validation. A points-based Pre-scope score was derived and compared with the DIANES score (DeLong test; R software v4.2.0).
Results:
Eight predictors were identified, including aneurysm diameter, stent diameter, stent-parent diameter ratio, branch artery involvement, coil assistance, aneurysm type, and location. The model shows good discriminative power with an AUC of 0.802 and good calibration. The model also provided good discrimination (AUC of 0.795) and good calibration in the validation cohort. After conversion into a points-based system, the Pre-scope score showed good discriminative ability, with AUCs of 0.775 and 0.794 in the training and validation cohorts, respectively. Compared with the DIANES score, this score has good discriminative ability (verification cohort AUC: 0.794 vs. 0.651, P ＜0.05).
Conclusion:
The Pre-scope score, based on a large multicenter dataset with independent temporal validation, is a practical preoperative tool with superior predictive ability. It may support individualized surgical strategies and improve patient outcomes.