The Journal of Cerebrovascular and Endovascular Neurosurgery

Abstract - Review Article

J Cerebrovasc Endovasc Neurosurg. 2024 26(1): 1-10

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

Yong-Hwan Cho1,2, Jaehyung Choi1,2, Chae-Wook Huh3, Chang Hyeun Kim4, Chul Hoon Chang5, Soon Chan KWON6, Young Woo Kim7, Seung Hun Sheen8, Sukh Que Park9, Jun Kyeung Ko10, Sung-kon Ha11, Hae Woong Jeong12, Hyen Seung Kang13, Clinical Practice Guideline Committee of the Korean Neuroendovascular Society14

1Department of Neurosurgery, Dong-A University Hospital, Busan, Korea, 2Department of Neurosurgery, Busan-Ulsan Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea, 3Department of Neurosurgery, Dong-Eui Hospital, Busan, Korea, 4Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea, 5Department of Neurosurgery, Yeungnam University Medical Center, Daegue, Korea, 6Department of Neurosurgery, Ulsan University Hospital, Ulsan, Korea, 7Department of Neurosurgery ,The Catholic University of Korea, Uijeongbu St. Mary’s Hospital, Uijeongbu, Korea, 8Department of Neurosurgery, CHA Bundang Medical Center of CHA University, Seongnam, Korea, 9Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Seoul, Korea, 10Department of Neurosurgery, Pusan National University Hospital, Busan, Korea, 11Department of Neurosurgery, Korea University Medical Center Ansan Hospital, Ansan, Korea, 12Department of Neurosurgery, Inje University Busan Paik Hospital, Busan, Korea, 13Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea, 14Clinical Practice Guideline Committee of the Korean Neuroendovascular Society

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 3R11;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.

Key words : R04;Intracranial aneurysm, Endovascular procedure, Consensus, Delphi technique