{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T06:24:31Z","timestamp":1784874271399,"version":"3.55.0"},"reference-count":35,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,11,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>The placement of flow-diverting devices has become a common method of treating unruptured intracranial aneurysms of the internal carotid artery. The progressive improvement of aneurysm occlusion after treatment\u2014with low complication and rupture rates\u2014has led to a dilemma regarding the management of aneurysms in which occlusion has not occurred within 6\u201324 months. The authors aimed to identify clinical consensus regarding management of intracranial aneurysms displaying persistent filling 6\u201324 months after flow diversion and to ascertain questions that may drive future investigation.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>An international panel of 67 experts was invited to participate in a multistep Delphi consensus process on the treatment of intracranial aneurysms after failed flow diversion.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Of the 67 experts invited, 23 (34%) participated. Qualitative analysis of an initial survey with open-ended questions resulted in 51 statements regarding management of aneurysms showing persistent filling after flow diversion. The statements were grouped into 8 categories, and in the second round, respondents rated the degree of their agreement with each statement on a 5-point Likert scale. Flow diverters with surface modifiers did not influence administration of dual-antiplatelet therapy according to 83%. Consensus was also reached regarding the definition of treatment failure at specific time points, including at 6 months if there is aneurysm growth or persistent rapid flow through the entirety of the aneurysm (96%), at 12 months if there is aneurysm growth or symptom onset (78%), and at 24 months if there is persistent filling regardless of size and filling characteristics (74%). Although experts agreed that the degree of intimal hyperplasia or in-device stenosis could not be ascertained by noninvasive imaging alone (83%), only 65% chose digital subtraction angiography as the preferred modality. At 6 and 12 months, retreatment is preferred if there is persistent filling with aneurysm growth (96%, 96%), device malposition (48%, 87%), or a history of subarachnoid hemorrhage (65%, 70%), respectively, and at 24 months if there is persistent filling without reduction in aneurysm size (74%). Experts favored treatment with an additional flow diverter (87%) over aneurysm clipping, applying the same principles for follow-up (83%) and treatment failure (91%) as for the first flow diverter.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>The authors present the consensus practices of experts in the management of intracranial aneurysms without occlusion 6\u201324 months after treatment with a flow-diverting device.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.3.jns2499","type":"journal-article","created":{"date-parts":[[2024,6,1]],"date-time":"2024-06-01T02:08:42Z","timestamp":1717207722000},"page":"1225-1234","source":"Crossref","is-referenced-by-count":7,"title":["Management of failed flow diversion for intracranial aneurysm beyond the first 6 months of follow-up: an international Delphi consensus"],"prefix":"10.3171","volume":"141","author":[{"given":"Renuka","family":"Chintapalli","sequence":"first","affiliation":[{"name":"School of Clinical Medicine, University of Cambridge, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Taussky","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah;"},{"name":"Department of Neurological Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramesh","family":"Grandhi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Dammann","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunal","family":"Raygor","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, New Jersey;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel A.","family":"Tonetti","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, New Jersey;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommy","family":"Andersson","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"White","sequence":"additional","affiliation":[{"name":"Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, Newcastle, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher S.","family":"Ogilvy","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rene","family":"Chapot","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. Christopher","family":"Fox","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Mayo Clinic Florida, Jacksonville, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rabih G.","family":"Tawk","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Mayo Clinic Florida, Jacksonville, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Lanzino","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Hanel","sequence":"additional","affiliation":[{"name":"Baptist Neurological Institute, Lyerly Neurosurgery, Jacksonville, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashutosh","family":"Jadhav","sequence":"additional","affiliation":[{"name":"Stroke Institute, Department of Neurology, University of 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