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Published on: August 11, 2015
ARISE I Consensus Review on the Management of Intracranial Aneurysms
Stavropoula I Tjoumakaris1, Ricardo Hanel2, J Mocco3
1Department of Neurosurgery, Thomas Jefferson University at Sidney Kimmel Medical College, Philadelphia, PA (S.I.T., K.E.N.).
Insights
Experts recommend artificial intelligence and nationwide data collection to improve the management of intracranial aneurysms (IAs). This collaborative approach aims to enhance diagnosis, monitoring, and rupture risk prediction for better patient outcomes.
Area of Science:
- Neurology and Neurosurgery
- Cerebrovascular Diseases
- Medical Device Technology
Background:
- Intracranial aneurysms (IAs) present significant morbidity and mortality challenges.
- Current treatment options lack definitive consensus, necessitating improved management strategies.
- A roundtable discussion convened experts to address best practices and novel approaches for IA management.
Framework:
- Experts convened to discuss clinical trials, preclinical research, management options, screening, monitoring, and novel device technologies for IAs.
- The discussion focused on improving outcomes for patients with intracranial aneurysms.
- Academia, industry, and federal regulators collaborated to advance IA care.
Implementation:
- Incorporation of artificial intelligence (AI) for aneurysm growth tracking and rupture risk prediction was suggested.
- Nationwide data collection of unruptured IA images is recommended for machine learning algorithm development.
- Support for centers of excellence in preclinical trials for genetics, cellular composition, and radiogenomics was emphasized.
Implications:
- AI and national registries can enhance IA diagnosis and monitoring.
- Multicenter collaborative efforts involving high-volume centers are crucial for clinical and preclinical research.
- Collaboration between academia, regulators, and industry is paramount for advancing IA management and the field.
Background:
Intracranial aneurysms (IAs) remain a challenging neurological diagnosis associated with significant morbidity and mortality. There is a plethora of microsurgical and endovascular techniques for the treatment of both ruptured and unruptured aneurysms. There is no definitive consensus as to the best treatment option for this cerebrovascular pathology. The Aneurysm, Arteriovenous Malformation, and Chronic Subdural Hematoma Roundtable Discussion With Industry and Stroke Experts discussed best practices and the most promising approaches to improve the management of brain aneurysms.
Methods:
A group of experts from academia, industry, and federal regulators convened to discuss updated clinical trials, scientific research on preclinical system models, management options, screening and monitoring, and promising novel device technologies, aiming to improve the outcomes of patients with IA.
Results:
Aneurysm, Arteriovenous Malformation, and Chronic Subdural Hematoma Roundtable Discussion With Industry and Stroke Experts suggested the incorporation of artificial intelligence to capture sequential aneurysm growth, identify predictors of rupture, and predict the risk of rupture to guide treatment options. The consensus strongly recommended nationwide systemic data collection of unruptured IA radiographic images for the analysis and development of machine learning algorithms for rupture risk. The consensus supported centers of excellence for preclinical multicenter trials in areas such as genetics, cellular composition, and radiogenomics. Optical coherence tomography and magnetic resonance imaging contrast-enhanced 3T vessel wall imaging are promising technologies; however, more data are needed to define their role in IA management. Ruptured aneurysms are best managed at large volume centers, which should include comprehensive patient management with expertise in microsurgery, endovascular surgery, neurology, and neurocritical care.
Conclusions:
Clinical and preclinical studies and scientific research on IA should engage high-volume centers and be conducted in multicenter collaborative efforts. The future of IA diagnosis and monitoring could be enhanced by the incorporation of artificial intelligence and national radiographic and biologic registries. A collaborative effort between academic centers, government regulators, and the device industry is paramount for the adequate management of IA and the advancement of the field.
