Intravenous VasoCT for the Follow-Up of Intracranial Aneurysms Treated with Flow-Diverter Stents: Feasibility and Exploratory Correlation with DSA

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Abstract
There is no consensus regarding the optimal imaging modality for assessing aneurysms treated with flow-diverters (FD). to evaluate the image quality of intravenous VasoCT (IV-VasoCT) in the follow-up of aneurysms treated with FD and to explore its potential for depicting braid stent deformation and vessel lumen modifications. we retrospectively enrolled patients who underwent FD placement for the treatment of aneurysms, with post-treatment IV-VasoCT at 1-3 months and DSA at least 6 months. IV-VasoCT image quality assessment evaluated: vessel opacification, vessel border, stent radiopacity, stent/vessel contrast, movement artefacts. Braid stent and parent vessel findings were compared between IV-VasoCT and DSA in terms of: neointimal lining, stent foreshortening, fish-mouthing, bumping, braid collapse. 26 aneurysms were evaluated in 24 patients (F/M: 15/9), with a median age of 54.5 years (IQR: 47.0-59.0 years). The in-consensus image quality reading evaluated: vessel opacification as optimal in 19 cases (73.1%), vessel borders as well-defined in 17 (65.4%); stent radiopacity as well-defined in 25 (96.2%), stent/vessel contrast as optimal in 20 (76.9%). Compared to DSA, IV-VasoCT diagnosed 2/3 (66%) cases of neointimal lining, 2/2 (100%) of fish-mouth, 1/2 (50%) of foreshortening, 3/6 (50%) of bumping, 2/2 (100%) of braid collapse. IV-VasoCT is feasible for the non-invasive follow-up of aneurysm treated with FD. It may depict modifications in braid stent and vessel neointimal lining, but the presence of coils may reduce its image quality because of artefacts.

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