Imaging follow-up strategy after endovascular treatment of Intracranial aneurysms: A literature review and guideline recommendations
10.7461/jcen.2024.E2023.08.008
- Author:
Yong-Hwan CHO
1
;
Jaehyung CHOI
;
Chae-Wook HUH
;
Chang Hyeun KIM
;
Chul Hoon CHANG
;
Soon Chan KWON
;
Young Woo KIM
;
Seung Hun SHEEN
;
Sukh Que PARK
;
Jun Kyeung KO
;
Sung-kon HA
;
Hae Woong JEONG
;
Hyen Seung KANG
;
Author Information
1. Department of Neurosurgery, Dong-A University Hospital, Busan, Korea
- Publication Type:Review Article
- From:Journal of Cerebrovascular and Endovascular Neurosurgery
2024;26(1):13-22
- CountryRepublic of Korea
- Language:EN
-
Abstract:
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.
