Imaging follow-up of unruptured intracranial aneurysms treated with flow diverter: Insights from a French collaborative survey

Abstract

Purpose

The absence of standardized guidelines for imaging follow-up of unruptured intracranial aneurysms treated with flow diverters (FD) results in significant variability across centers. This survey aims to provide a comprehensive overview of current imaging follow-up practices in French academic centers.

Methods

In April 2024, a 49-question survey was distributed to interventional neuroradiology centers in France through the trainee-led research collaborative network, Jeunes En Neuroradiologie Interventionnelle-Research Collaborative (JENI-RC). The survey covered follow-up protocols for digital subtraction angiography (DSA), magnetic resonance imaging (MRI), and computed tomography (CT), as well as potential modifications for specific cases.

Results

Twenty interventional neuroradiology centers responded to the survey. Most centers (n = 14, 70 %), conducted a single systematic DSA either at 6 or 12 months post-procedure. In most centers (n = 13, 65 %), a second DSA was scheduled only based on the results of the first, specifically in cases of non-occluded aneurysm, intimal hyperplasia, or in-stent stenosis. MRI follow-up varied, with most centers (n = 12, 60 %) performing three MRIs over five years. Only two centers included CT scans in their protocols.

Conclusion

This survey highlights the substantial heterogeneity in imaging follow-up protocols for FD-treated unruptured intracranial aneurysms among French academic centers. The findings underscore the urgent need for standardized guidelines to harmonize practices, optimize patient outcomes, and improve resource utilization. Additionally, innovations in FD technology, advancements in MRI sequences, and the advent of photon-counting CT will likely influence follow-up practices in the near future.