Estratificación de Riesgos y Vigilancia Después de la Cobertura Endovascular de Aneurismas Intracraneales: Desarrollo...

Aneurysm recurrence after endovascular coiling remains a clinically relevant issue, particularly for determining appropriate post-treatment surveillance. However, standardized risk stratification to guide follow-up intensity is lacking. This study aimed to identify predictors of early recurrence and to develop a simplified risk stratification tool to inform post-coiling surveillance.

We retrospectively analyzed 432 intracranial aneurysms with adequate follow-up among 487 aneurysms treated with endovascular coiling between January 2021 and December 2023. Clinical and angiographic variables included aneurysm size, morphology (bifurcation vs. sidewall), rupture status, Raymond-Roy occlusion classification (RROC), and treatment modality. Recurrence was defined as coil compaction, neck recurrence, or sac regrowth. Time-to-recurrence was assessed using Cox proportional-hazards modeling, and model performance was evaluated using receiver operating characteristic analysis and the Hosmer-Lemeshow test.

During a mean follow-up of 14 ± 9 months, recurrence occurred in 25 aneurysms (5.8%), with retreatment required in 9 (2.1%). Independent predictors of recurrence were aneurysm size ≥10 mm (HR 4.28, p < 0.001), residual sac (RROC III; HR 6.96, p < 0.001), and bifurcation morphology (HR 2.42, p = 0.028). Stent-assisted coiling showed a borderline protective trend (HR 0.59, p = 0.15). The final model demonstrated good discrimination (AUC 0.86) and calibration (Hosmer-Lemeshow p = 0.74). Based on these factors, the simplified RACE scale stratified aneurysms into low (1-2%), moderate (6-8%), and high-risk (15-20%) recurrence groups.

The RACE scale provides a practical framework for early recurrence risk stratification after endovascular coiling and may assist post-coiling imaging surveillance, particularly for high-risk aneurysms.