CTA-derived hemodynamic parameters and inflammatory biomarkers in predicting post- embolization vasospasm in ruptured intracranial aneurysms

Abstract

Objective: To investigate the predictive value of CTA-derived hemodynamic parameters and readily accessible systemic inflammatory indices for post-embolization vasospasm (PEV) and 3-month functional outcomes in patients with ruptured intracranial aneurysms (RIAs).

Methods: In this prospective cohort study, 230 patients undergoing endovascular coiling within 72 hours of ictus were enrolled. Computational fluid dynamics (CFD) simulations based on preoperative CTA were used to quantify hemodynamic parameters (TAWSS, OSI, RRT). Preoperative serum procalcitonin (PCT), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) were also measured. The primary outcome was 3-month functional status, dichotomized into improved (GOS 4–5) versus poor (GOS 1–3) outcomes.

Results: Poor outcomes occurred in 29.8% of the development cohort and 30.8% of the validation cohort. Multivariable analysis identified Hunt–Hess grade IV–V, TAWSS, PCT, and NLR as independent predictors of poor functional outcome. The resulting nomogram demonstrated excellent discrimination (AUC = 0.89 in the development cohort; AUC = 0.85 in the validation cohort) and satisfactory calibration. PEV developed in 21.3% of the development cohort and was significantly associated with poor outcomes.

Conclusion: Integrating CTA-derived hemodynamic parameters with readily available systemic inflammatory indices reliably predicts PEV and functional outcomes in RIAs, providing a clinically applicable tool for early risk stratification.