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Evaluation of flow diverters for cerebral aneurysm therapy: recommendations for imaging analyses in clinical studies, endorsed by ESMINT, ESNR, OCIN, SILAN, SNIS, and WFITN
Journal article   Open access   Peer reviewed

Evaluation of flow diverters for cerebral aneurysm therapy: recommendations for imaging analyses in clinical studies, endorsed by ESMINT, ESNR, OCIN, SILAN, SNIS, and WFITN

Jens Fiehler, Santiago Ortega-Gutierrez, Vania Anagnostakou, Jonathan Cortese, H Saruhan Cekirge, David Fiorella, Ricardo Hanel, Zsolt Kulcsar, Saleh Lamin, Jianmin Liu, …
Journal of neurointerventional surgery, Vol.17(6), pp.632-639
06/2025
DOI: 10.1136/jnis-2023-021404
PMCID: PMC12171491
PMID: 38830670
url
https://doi.org/10.1136/jnis-2023-021404View
Published (Version of record) Open Access

Abstract

Background Multiple studies and meta-analyses have described the technical and clinical outcomes in large cohorts of aneurysm patients treated with flow diverters (FDs). Variations in evaluation methodology complicate making comparisons among studies, hinder understanding of the device behavior, and pose an obstacle in the assessment of further advances in FD therapy.Methods A multidisciplinary panel of neurointerventionalists, imaging experts, and neuroradiologists convened with the goal of establishing consensus recommendations for the standardization of image analyses in FD studies.Results A standardized methodology is proposed for evaluating and reporting radiological outcomes of FD treatment of intracranial aneurysms. The recommendations include general imaging considerations for clinical studies and evaluations of longitudinal changes, such as neointimal lining and stenosis. They cover standards for classification of aneurysm location, morphology, measurements, as well as the assessment of aneurysm occlusion, wall apposition, and neck coverage. These reporting standards further define four specific braid deformation patterns: foreshortening, fish-mouthing, braid bump deformation, and braid collapse, collectively termed ‘F2B2’.Conclusions When widely applied, standardization of methods of measuring and reporting outcomes will help to harmonize the assessment of treatment outcomes in clinical studies, help facilitate communication of results among specialists, and help enable research and development to focus on specific aspects of FD techniques and technology.
Angiography Aneurysm Flow Diverter Hemorrhagic stroke Standards Subarachnoid

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