ReviewClinical neuroradiology2026
Patient Management After Flow Diversion for Unruptured Intracranial Aneurysms: a Literature Review and DELPHI Consensus.
Review in Clinical neuroradiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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30 authors.
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Abstract
backgroundUnruptured intracranial aneurysms are a common and can have devastating outcomes if ruptured. Flow diversion has expanded treatment options, especially for wide-necked and blister aneurysms. Yet, optimal follow-up retreatment strategies in case of treatment failure remain unclear. A DELPHI consensus was initiated to understand current practice in aneurysm management after flow diverter treatment.
methodsThis DELPHI consensus was conducted during the 5 T Think Tank, following a scoping literature review. Experts discussed the results, responded to iterative questionnaires, which started with four open-ended questions, and concluded with ten closed-ended questions.
resultsOf the 40 attendees, 24 participants (60%) identified as experts in flow diversion and participated in the DELPHI process, which involved a literature search and three DELPHI rounds. Consensus was reached on performing the first assessment of the flow diverter during the procedure using cone-beam CT (77.8%), and on timing of the first follow up (at 6 months, 70.8%). For follow-up timing, an annual (57%) or semi-annual (43%) schedule was favored. No preference emerged for the follow-up imaging modality, with slight preferences for MRA (29%), followed by DSA (25%), DSA + MRA (21%), CTA (17%), and DSA + CTA (8%). Aneurysm growth (> 2 mm) was identified as a key criterion for retreatment. It was thought that combining clinical and angiographic metrics should be a key research priority, as it could potentially improve retreatment decision making compared to a purely angiographic outcome.
conclusionThis DELPHI consensus highlights the complexity of decision-making for unruptured intracranial aneurysms. Despite these challenges, there was consensus among international experts on follow-up timing and decision drivers for retreatment.
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