Literature review and DELPHI consensus on follow-up and retreatment of intracranial aneurysms with intrasaccular devices

Alexander Stebner, Department of Clinical Neurosciences, Foothills Medical Center, University of Calgary, AB, Calgary, Canada.
Petra Cimflova, Department of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland.
Salome L. Bosshart, Department of Clinical Neurosciences, Foothills Medical Center, University of Calgary, AB, Calgary, Canada.
Marie-Sophie Schüngel, Policlinic of Radiology and Interventional Radiology, Department of Neuroradiology, University Hospital Halle, Halle (Saale), Germany.
Satoru Fujiwara, Department of Neurology, Kobe City Medical Center General Hospital, Kobe, Japan.
Genevieve Milot, Department of Surgery, Laval University, Quebec, Quebec City, Canada.
David Volders, Department of Radiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Kazutaka Uchida, Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Hyogo, Japan.
Christine Hawkes, Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Manuel Moreu, Radiology Department, Hospital Clinico San Carlos, Madrid, Spain.
Isabel Fragata, Department of Neuroradiology, ULS São José, Lisbon, Portugal.
Alexandra Paul, Department of Neurosurgery, Albany Medical Center, Albany, New York, USA.
Umberto Pensato, Department of Neurology, IRCCS Humanitas Research Hospital, Milano, Italy.
Christian Ulfert, Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany.
Donald Frei, Department of Neuroradiology, Colorado Neurological Institute, Denver, Colorado, USA.
Pervinder Bhogal, Department of Neuroradiology, The Royal London Hospital, Barts NHS Trust, London, UK.
Joanna Schaafsma, Division of Neurology, Department of Medicine (JDS) and Division of Neuroradiology, Department of Medical Imaging, University Health Network, Toronto, Canada.
Sandor Nardai, Department of Neurointervention, Semmelweis University Center of Neurosurgery and Neurointervention, Budapest, Hungary.
Syed Zaidi, Department of Neurology, University of Toledo, Toledo, Ohio, USA.
Mohammed Almekhlafi, Department of Clinical Neurosciences, Foothills Medical Center, University of Calgary, AB, Calgary, Canada.
Shahid Nimjee, Department of Neurosurgery, Ohio State University Wexner Medical Center, Columbus, USA.
Pascal Mosimann, Division of Interventional and Diagnostic Neuroradiology, Department of Radiology, University of Toronto & Toronto Western Hospital, Ontario, Canada.
James Kennedy, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
Jeremy Rempel, Department of Radiology, University of Alberta Hospital, University of Alberta, Edmonton, Canada.
Violiza Inoa, Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Shinichi Yoshimura, Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Hyogo, Japan.
Marc Ribo, Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain.
Demetrius Lopes, Advocate Health - MidwestFollow
John Wong, Department of Clinical Neurosciences, Foothills Medical Center, University of Calgary, AB, Calgary, Canada.
Johanna Ospel, Department of Clinical Neurosciences, Foothills Medical Center, University of Calgary, AB, Calgary, Canada.

Affiliations

Advocate Illinois Masonic Medical Center

Abstract

Background: Intracranial aneurysms are increasingly detected incidentally due to broader use of neuroimaging. Intrasaccular devices are frequently used to prevent rupture, yet standardized follow-up and retreatment strategies remain undefined. We performed a scoping literature review and DELPHI consensus to gauge current practice patterns and expert opinions on managing intracranial aneurysms that were previously treated with intrasaccular devices.

Methods: A DELPHI consensus was conducted during an invite-only meeting of international neurointerventional experts. The process was informed by a scoping literature review and included three iterative rounds of structured questionnaires to establish consensus on follow-up imaging timing, modality, and retreatment decision-making.ResultsTwenty-four experts participated. The literature review identified 16 key studies, which were presented to the panel. For completely occluded aneurysms, MRA at 6 months was preferred by 58% of participants, with annual imaging favored thereafter. For incompletely occluded aneurysms, 6-month DSA followed by annual imaging was recommended. No consensus was reached on the imaging modality for annual follow-up. Retreatment decisions were primarily driven by aneurysm growth (>2 mm). Endovascular retreatment was preferred over open surgery, with risks such as ischemia and rupture identified as key concerns.

Conclusion: This DELPHI consensus highlights current practice trends and open questions in the follow-up and retreatment of aneurysms treated with intrasaccular devices.

Document Type

Article

PubMed ID

40990642

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