As a result of a minor car accident, a 40 year old subject has presented at the Hospital. She underwent a CT examination to screen possible lesions and an unrelated and asymptomatic cerebral aneurysm was diagnosed. Subsequent CT angiography has provided improved image data for characterisation of the morphology of the aneurysm.

Blood samples have been taken and screening for genes that aneurIST has associated, by data mining, with rupture risk has been performed. Treatment of this patient depends on quantification of her individual risk of rupture. If intervention, surgical or endovascular, is indicated, which treatment protocol and, if relevant, which device is optimal?

The @neuRisk suite of programmes is run by the clinician and his/her support team composed of trained bioengineers to provide a quantitative and individualised risk of rupture score for this patient. This will integrate factors from the patient's electronic health record (EHR), including genetic or phenotypical information if available and appropriate, from the Primary Healthcare database, and from personalised morphodynamic, structural and haemodynamic characterisation with knowledge extracted from publicly available data from scientific and epidemiological studies.

In our hypothetical scenario it might be that @neuRisk supports the decision that the patient is at risk due to a focused area with unusually high flow impingement and high local tissue strains, to over expression of the eNOS gene, which has been shown to correlate with rupture, to systemic hypertension and to presence of lifestyle risk factors including smoking. The system also points to a number of very recent studies from the literature that, although not considered in rendering the personalized guideline, matches the patient profile and may provide additional information to the clinician. These additional studies are organized in two groups: those supporting the previous decision and those studies which might contradict the supported decision. In this case, no study was found in this last category. A recent paper by Slowik et al (2004) seems to suggest an association between the Insertion allele of the ACE gene with ruptured intracranial aneurysms. The clinician therefore wants to verify the presence of this modified gene in the patient by querying the patients' EHR and retrieving the results of her biochip analysis that discloses a positive test.

The patient is finally informed about the risks and benefits of treatment versus non-treatment and that, based on all the available information, a personalized treatment guideline has been developed for her, which suggests that endovascular treatment is indicated in her case. She feels confident about the recommendation as she understands that a comprehensive assessment has been carried out that takes into account both the latest technology available and the latest scientific advances in the field. During the therapy, the actual interventional procedure is optimally supported by advanced functionality of the imaging system, providing treatment management tools assuring maximal clinical outcome. Furthermore, through the @neuEndo exploitation path, aneurIST has contributed to the customization of a novel endovascular device that has characteristics that make it particularly appropriate for intervention in this case.

Finally, the results of this case will, with appropriate permission, be stored in the aneurIST databases with the aim of providing further historical evidence to support the next generation of risk assessment and interventional planning.