Imaging follow-up strategy after endovascular treatment of Intracranial aneurysms: A literature review and guideline recommendations

• Published in: Journal of cerebrovascular and endovascular neurosurgery Vol. 26; no. 1; pp. 1 - 10
• Main Authors: Cho, Yong-Hwan, Choi, Jaehyung, Huh, Chae-Wook, Kim, Chang Hyeun, Chang, Chul Hoon, KWON, Soon Chan, Kim, Young Woo, Sheen, Seung Hun, Park, Sukh Que, Ko, Jun Kyeung, Ha, Sung-kon, Jeong, Hae Woong, Kang, Hyen Seung
• Format: Journal Article
• Language: English
• Published: Korea (South) 대한뇌혈관외과학회 01.03.2024
• Subjects: 신경외과학; Endovascular procedure; Delphi technique; Intracranial aneurysm; Consensus
• ISSN: 2234-8565; 2287-3139
• DOI: 10.7461/jcen.2024.E2023.08.008

Objective: Endovascular coil embolization is the primary treatment modality for intracranial aneurysms. However, its long-term durability remains of concern, with a considerable proportion of cases requiring aneurysm reopening and retreatment. Therefore, establishing optimal follow-up imaging protocols is necessary to ensure a durable occlusion. This study aimed to develop guidelines for follow-up imaging strategies after endovascular treatment of intracranial aneurysms.Methods: A committee comprising members of the Korean Neuroendovascular Society and other relevant societies was formed. A literature review and analyses of the major published guidelines were conducted to gather evidence. A panel of 40 experts convened to achieve a consensus on the recommendations using the modified Delphi method.Results: The panel members reached the following consensus: 1. Schedule the initial follow-up imaging within 3-6 months of treatment. 2. Noninvasive imaging modalities, such as three-dimensional time-of-flight magnetic resonance angiography (MRA) or contrast-enhanced MRA, are alternatives to digital subtraction angiography (DSA) during the first follow-up. 3. Schedule mid-term follow-up imaging at 1, 2, 4, and 6 years after the initial treatment. 4. If noninvasive imaging reveals unstable changes in the treated aneurysms, DSA should be considered. 5. Consider late-term follow-up imaging every 3–5 years for lifelong monitoring of patients with unstable changes or at high risk of recurrence.Conclusions: The guidelines aim to provide physicians with the information to make informed decisions and provide patients with high-quality care. However, owing to a lack of specific recommendations and scientific data, these guidelines are based on expert consensus and should be considered in conjunction with individual patient characteristics and circumstances.