P164 Retrospective application of risk scores to unruptured anterior communicating artery aneurysms

<h3>Introduction</h3> Treatment decisions for unruptured intracranial aneurysms (UIAs) pose a challenge for neurosurgeons, prompting the development of clinical scales assessing hemorrhage risk to provide management guidance. <h3>Aim of Study</h3> This study compares recommendations from the PHASES and UIA treatment scores (UIATS) applied to anterior communicating artery (AComA) UIAs against real-world management. <h3>Methods</h3> While UIATS recommends management, for PHASES, an aneurysm with score of 10 or more was considered ’high-risk’. Analysis involved assessing the concordance in each group alongside comparison to real-word management <h3>Results</h3> Among 129 patients, 46.5% were observed and 53.5% were treated. PHASES scores were significantly higher in the treatment group (<i>p</i> = 0.00002), and UIATS recommendations correlated with real-world decisions (<i>p</i> &lt; 0.001). We observed no difference in the frequencies of UIATS recommendations between high- and low-risk groups. When comparing the UIATS and PHASES, 33% of high-risk aneurysms received a UIATS conservative management recommendation. In 39% of high-risk aneurysms, the UIATS recommendation was not definitive. Conversely, 27% of low-risk aneurysms obtained a UIATS UIA repair recommendation. Overall, concordance between PHASES and UIATS was 32% <h3>Conclusion</h3> Significant discordance in therapeutic suggestions underscores the predominant influence of center experience and individual assessments. Future studies should refine and validate decision-making strategies, potentially exploring alternative applications or developing tailored scales. <h3>Disclosure of Interest</h3> no.