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

BackgroundIntracranial 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.MethodsA 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.ConclusionThis DELPHI consensus highlights current practice trends and open questions in the follow-up and retreatment of aneurysms treated with intrasaccular devices.

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Journal
Interventional Neuroradiology
Published
2025-09-24
DOI
https://doi.org/10.1177/15910199251380361
Primary Topic
Intracranial Aneurysms: Treatment and Complications
Type
article
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article

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

Umberto Pensato, Marie-Sophie Schüngel, Demetrius K. Lopes, Joanna D. Schaafsma et al.
Interventional Neuroradiology
Intracranial Aneurysms: Treatment and Complications
article

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

Umberto Pensato, Marie-Sophie Schüngel, Demetrius K. Lopes, Joanna D. Schaafsma, Satoru Fujiwara, Shahid M. Nimjee, Christine Hawkes, Johanna Maria Ospel, James Kennedy, David Volders, Alexandra Paúl, Mohammed Almekhlafi, Pascal J. Mosimann, Petra Cimflová, Geneviève Milot, Syed Usama Shayan Zaidi, Christian Ulfert, Manuel Moreu, Violiza Inoa, Marc Ribó, Sándor Nardai, Alexander Stebner, Isabel Fragata, Pervinder Bhogal, Jeremy Rempel, Kazutaka Uchida, Donald Frei, John H. Wong, Salome Lou Bosshart, Shinichi Yoshimura
article en

Abstract

BackgroundIntracranial 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.MethodsA 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.ConclusionThis DELPHI consensus highlights current practice trends and open questions in the follow-up and retreatment of aneurysms treated with intrasaccular devices.

Interventional Neuroradiology
Semmelweis University (HU), Universitat Autònoma de Barcelona (ES), Dalhousie University (CA), Sunnybrook Health Science Centre (CA), University Health Network (CA), Humanitas University (IT), University of Tennessee Health Science Center (US), University of Toronto (CA), Masaryk University (CZ), Heidelberg University (DE), Barts Health NHS Trust (GB), Toronto Western Hospital (CA), University Hospital of Bern (CH), University Hospital Heidelberg (DE), ProMedica Toledo Hospital (US), Health Sciences Centre (CA), Foothills Medical Centre (CA), The Ohio State University Wexner Medical Center (US), University of Alberta Hospital (CA), Hospital Clínico San Carlos (ES), University of Oxford (GB), Hospital de São José (PT), ProMedica Russell J. Ebeid Children's Hospital (US), Nova Medical (United States) (US), Advocate Illinois Masonic Medical Center (US), Colorado Neurological Institute (US), Vall d'Hebron Hospital Universitari (ES), University Hospital in Halle (DE), Kobe City Medical Center General Hospital (JP), IRCCS Humanitas Research Hospital (IT), Université Laval (CA), Albany Medical Center Hospital (US), Universidade Nova de Lisboa (PT), Hyogo University (JP), University of Toledo (US)
Openalex Percentile: Top 63%
Intracranial Aneurysms: Treatment and Complications
DOIOpen Access PDFOpenAlex
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