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Original research
An outcomes-based grading scale for the evaluation of cerebral aneurysms treated with flow diversion
  1. Min S Park1,
  2. Marcus D Mazur1,
  3. Karam Moon2,
  4. Michael J Nanaszko2,
  5. John R W Kestle1,
  6. Lubdha M Shah3,
  7. Blair Winegar3,
  8. Felipe C Albuquerque2,
  9. Philipp Taussky1,
  10. Cameron G McDougall2
  1. 1 Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
  2. 2 Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
  3. 3 Department of Radiology, University of Utah, Salt Lake City, Utah, USA
  1. Correspondence to Dr Min S Park, Department of Neurosurgery, University of Utah Health Care, 175 North Medical Drive East, Salt Lake City, UT 84132, USA; neuropub{at}


Object Despite the popularity of flow-diverting stents for the treatment of cerebral aneurysms, there is no widely accepted scale for the characterization of results. We present an outcomes-based grading scale that considers factors related to failure of flow diversion.

Methods The grading scale was developed using the results from consecutive patients at two institutions who were treated with flow diversion for a cerebral aneurysm. The initial treatment results were graded on patient, aneurysm, and treatment characteristics. A 6-point grading scale was developed based on these data.

Results One hundred and seventy-one patients were included in the patient cohort. When compared by multivariate analysis with patients without residuals, patients with aneurysm residuals were found to be older (age ≥60 years, p=0.01, OR 1.17, 95% CI 1.03 to 1.33), to have larger aneurysms (size ≥15 mm, p<0.01, OR 1.38, 95% CI 1.17 to 1.62), to have aneurysms with associated side branches (p=0.02, OR 1.17, 95% CI 1.03 to 1.33), and to have a post-treatment Raymond score of 2 or 3 (p=0.01, OR 1.28, 95% CI 1.06 to 1.56). Using the Raymond score (1–3) as the foundation for the grading scale, additional points (0 or 1) were given for the other three identified factors, creating a 6-point scale. We found that patients with residual aneurysms had statistically higher final tabulated scores (p<0.01).

Conclusions We propose a novel straightforward outcomes-based scale to characterize results after flow diversion treatment of cerebral aneurysms. This scale may provide the basis for the common reporting of results in future studies.

  • Flow Diverter
  • Aneurysm

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  • MSP and MDM are joint first authors.

  • Contributors Concept and design: MSP, CGMcD. Data collection: MSP, MDM, KM, MJN, LMS, BW. Manuscript preparation: MSP, MDM. Editorial oversight: MSP, FCA, PT, JRK, CGMcD. Final approval: MSP, CGMcD.

  • Competing interests PT is a consultant for Covidien and proctors physicians in the use of the PED.

  • Ethics approval Ethics approval was obtained from the University of Utah and Barrow Neurological Institute institution review boards.

  • Provenance and peer review Not commissioned; externally peer reviewed.