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Background <p>Unruptured intracranial aneurysms are a&#xa0;common and can have devastating outcomes if ruptured. Flow diversion has expanded treatment options, especially for wide-necked and blister aneurysms. Yet, optimal follow-up retreatment strategies in case of treatment failure remain unclear. A&#xa0;DELPHI consensus was initiated to understand current practice in aneurysm management after flow diverter treatment.</p> Methods <p>This DELPHI consensus was conducted during the 5 T Think Tank, following a&#xa0;scoping literature review. Experts discussed the results, responded to iterative questionnaires, which started with four open-ended questions, and concluded with ten closed-ended questions.</p> Results <p>Of the 40&#xa0;attendees, 24&#xa0;participants (60%) identified as experts in flow diversion and participated in the DELPHI process, which involved a&#xa0;literature search and three DELPHI rounds. Consensus was reached on performing the first assessment of the flow diverter during the procedure using cone-beam CT (77.8%), and on timing of the first follow up (at 6&#xa0;months, 70.8%). For follow-up timing, an annual (57%) or semi-annual (43%) schedule was favored. No preference emerged for the follow-up imaging modality, with slight preferences for MRA (29%), followed by DSA (25%), DSA + MRA (21%), CTA (17%), and DSA + CTA (8%). Aneurysm growth (&gt; 2 mm) was identified as a&#xa0;key criterion for retreatment. It was thought that combining clinical and angiographic metrics should be a&#xa0;key research priority, as it could potentially improve retreatment decision making compared to a&#xa0;purely angiographic outcome.</p> Conclusion <p>This DELPHI consensus highlights the complexity of decision-making for unruptured intracranial aneurysms. Despite these challenges, there was consensus among international experts on follow-up timing and decision drivers for retreatment.</p>

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Patient Management After Flow Diversion for Unruptured Intracranial Aneurysms: a Literature Review and DELPHI Consensus

  • 期刊论文

  • 发表日期：

    2025年12月19日

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  • Alexander Stebner,
  • Marie-Sophie Schüngel,
  • Salome Lou Bosshart,
  • Satoru Fujiwara,
  • Genevieve Milot,
  • David Volders,
  • Kazutaka Uchida,
  • Christine Hawkes,
  • Petra Cimflova,
  • Manu Moreu,
  • Isabel Fragata,
  • Alexandra Paul,
  • Umberto Pensato,
  • Christian Ulfert,
  • Donald Frei,
  • Pervinder Bhogal,
  • Joanna Schaafsma,
  • Sandor Nardai,
  • Syed Zaidi,
  • Mohammed Almekhlafi,
  • Shahid Nimjee,
  • Pascal Mosimann,
  • James Kennedy,
  • Jeremy Rempel,
  • Violoza Inoa,
  • Shinichi Yoshimura,
  • Marc Ribo,
  • Demetrius Lopes,
  • John Wong,
  • Johanna Ospel

摘要

Background

Unruptured intracranial aneurysms are a common and can have devastating outcomes if ruptured. Flow diversion has expanded treatment options, especially for wide-necked and blister aneurysms. Yet, optimal follow-up retreatment strategies in case of treatment failure remain unclear. A DELPHI consensus was initiated to understand current practice in aneurysm management after flow diverter treatment.

Methods

This DELPHI consensus was conducted during the 5 T Think Tank, following a scoping literature review. Experts discussed the results, responded to iterative questionnaires, which started with four open-ended questions, and concluded with ten closed-ended questions.

Results

Of the 40 attendees, 24 participants (60%) identified as experts in flow diversion and participated in the DELPHI process, which involved a literature search and three DELPHI rounds. Consensus was reached on performing the first assessment of the flow diverter during the procedure using cone-beam CT (77.8%), and on timing of the first follow up (at 6 months, 70.8%). For follow-up timing, an annual (57%) or semi-annual (43%) schedule was favored. No preference emerged for the follow-up imaging modality, with slight preferences for MRA (29%), followed by DSA (25%), DSA + MRA (21%), CTA (17%), and DSA + CTA (8%). Aneurysm growth (> 2 mm) was identified as a key criterion for retreatment. It was thought that combining clinical and angiographic metrics should be a key research priority, as it could potentially improve retreatment decision making compared to a purely angiographic outcome.

Conclusion

This DELPHI consensus highlights the complexity of decision-making for unruptured intracranial aneurysms. Despite these challenges, there was consensus among international experts on follow-up timing and decision drivers for retreatment.