@neurIST : Intregrated Biomedical Informatics for the Management of Cerebral Aneurysms

Study Overview
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Brief Summary
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The primary aim of the SwissNeuroFoundation AneurysmDataBase Project is to implement information technology based tools to create and use a holistic reference database specific to intracranial aneurysms (IA). The SwissNeuroFoundation AneurysmDataBase are concerned with generating the data with which to populate this database. The purpose for populating the database are to: Screen for and evaluate markers of risk for intracranial aneurysm formation and aneurysm rupture. Are considered as markers the following: genetics factors, microbiota, environmental factors, congenital factors (ie: cerebrovascular anatomical variants), transcriptomics signature, proteomics signature,shape characteristics, haemodynamics characteristics. Screen for and evaluate prognostic factors of outcome regarding different management strategies including watchful observation, microsurgical treatment, endovascular treatment or any combination thereof. Implement and evaluate patient-specific management protocols integrating all available information. Evaluate the impact of the database and use of tools to improve care, reduce costs, support knowledge discovery and promote new industrial developments.

Detailed Description
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Clinical history, imaging data, biological samples and information derived from are the main items to be captured to the SwissNeuroFoundation AneurysmDataBase. No limits are set on the number of healthy volunteers and patient cases for whom data can be entered to the SwissNeuroFoundation AneurysmDataBase. Participants will be recruited from the following sources: Patients arriving at partner clinical centers either as newly diagnosed (incidental cases) or already known for the disease (prevalent cases) Healthy volunteers answering a call, randomly selected subjects from a known population that consent to participate or non genetically linked family members of patients that consent to participate Family members of patients identified as having a familial history of intracranial aneurysm (IA). Points of consent: The specific items on which participants are asked to consent: to having been verbally informed of the aims of the project to having read the information sheet about the project, been able to ask questions about the project, and to having received satisfactory answers and enough time to make the decision. to having been informed that any damage that could be directly caused by the participation to the project is covered by insurance. that hospital care providers working on behalf of the project and representatives of the local authorities and ethics commission may access in a strictly confidential term raw data for quality check. to having been informed that participation can be withdrawn anytime without justification and will result in a medical assessment for own security. There will be no impact on future care resulting from withdrawal. to be free to refuse answering questions without requiring any justification and it will have no impact on future care. to understand that data may be used in a non-identifying form for publication. to understand that data provided may form part of future commercial applications, and will not benefit financially from this. to understand and agree that coded data may be used for further cerebrovascular-related research. that they understand that coded data about them or biological samples may be transferred outside the European Union. The specific items on which participants are asked to agree or disagree: that they agree to provide access to health records, to provide a link from them to the SwissNeuroFoundation AneurysmDataBase, and to complete a questionnaire on their clinical history. give agreement to provide image data to SwissNeuroFoundation AneurysmDataBase. give agreement to provide blood samples to SwissNeuroFoundation AneurysmDataBase. give agreement to use biological samples resulting from therapeutical intervention. give agreement to use saliva and stool samples to SwissNeuroFoundation AneurysmDataBase. give agreement to be re-contacted by SwissNeuroFoundation AneurysmDataBase for further consent or to request further information. give agreement to inform the General Practitioner about the participation to the project. give agreement to contact the General Practitioner to request information on participant whereabouts or limited relevant medical information, if direct contact was unsuccessful during 3 months. request to be informed by the clinician in charge about observations resulting from the project that may have a significant impact on the participant health. request the General Practitioner of the participant to be informed about observations resulting from the project that may have a significant impact on the participant health. Separate specific points of consent relative to biological samples and genetics: having read the genetic testing information sheet, been able to ask questions about genetic testing, and understanding why the research is being done and any risks involved give agreement to provide blood samples to SwissNeuroFoundation AneurysmDataBase understanding that genetic data arising from samples may form part of future commercial applications, and that they will not benefit financially from this. understanding that they are free to withdraw at any time and may ask for their sample to be destroyed then, or at any other time. agree that blood samples be stored and used for genetic analysis. agree that blood, aneurysm dome, cerebrospinal fluid (CSF) and microdialysis samples be stored and used for further cerebrovascular-related research. agreement that blood samples may be transferred with coded labels to other Universities in the World. For the purpose of the AneurysmDataBase: Clinical Information consists of: Demographic information (Pseudonym, Age, Gender, Size, Weight, work and sport activities, habits: smoking, alcool consumption). Personal medical history (Previous strokes, previous epilepsy, previous medication) Family tree denoting known or likely diagnosed IA or subarachnoid hemorrhage (SAH) events. Signs and symptoms (date of ictus, date of diagnosis, mRankin score, Glasgow Coma Scale (GCS), NIH Stroke Scale (NIHSS),Mini Mental State Exam (MMSE), World Federation of Neurosurgeons Scale WFNS, Cranial nerve deficits) Identified epidemiology factors according to check list. Imaging analysis (Presence of SAH, Fisher grade, size of ventricles, size of basal cisterns, volume of hematoma and location, number of aneurysms, location of aneurysms, size of aneurysms, shape of aneurysm) Treatment and outcome information (treatment method, success) Follow-up and outcome information (Quality of life assessment, MMSE, mRankin, NIHSS, Cranial nerve deficits, aneurysms status: stable, growth, treated, partially treated) Imaging Data consist of: Pseudonymised DICOM files of: MRI angiography (MRA) Computed Tomography Angiography (CTA) 3D reconstruction of Digital Rotation Angiography (3D-DRA) Samples consist of: Blood in DNA saving solution Blood in RNA saving solution Blood in EDTA CSF Aneurysm dome Saliva Stool Other biological sample to be specified

Official Title
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@neurIST : Informatique biomédicale intégrée Pour la Gestion Des anévrismes cérébraux

Conditions
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Intracranial Aneurysm

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: able to provide consent or, in the event that a patient is incapable of providing consent, that a person is legally authorized to do so on behalf of the patient according to legal and ethical requirements of the country where the clinical centre is located. Patients: must have an angiographically proven intracranial aneurysm (MRA< CTA< DSA accepted).The determination of SAH requires the presence of a subarachnoid haemorrhage be verified on CT or by lumbar puncture. MRA: Magnetic Resonance Angiography CTA: Computed Tomography Angiography DSA: Digital Subtracted Angiography Exclusion Criteria: failure of a candidate to contribute clinical data, refusal to provide informed consent.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| IA Patients<br>Patients with one or more identified intracranial aneurysm, none of which are believed to have ruptured. | |
| IA + SAH Patients<br>Patients with one or more identified intracranial aneurysm, at least one of which has been radiologically or surgically determined to have ruptured. | |
| Familiy members<br>Individuals selected on review of a patient's family tree and contacted by said patient, who agree to be approached for recruitment. In affected families each member will be identified as: proband, affected, unaffected, unknown, or not genetically linked. | |
| Healthy Volunteers<br>Individuals, accompanying or contacted by a patient, or responding to open advertisement, or randomly selected in a defined population who agree to be approached for recruitment. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Disease model validation | Validation and improvement of the holistic disease model | 5 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Life expectancy | Age at death | 20 years | 
| Disability | Disease induced disability on modified Rankin scale and duration of disability | 20 years | 
| Cure | Absence of new treatments or bleeding after initial treatment | 20 years | 
| Adverse events | Aneurysm rupture after diagnosis or treatment related severe complications | 20 years | 
| Aneurysm growth | Observation of the growth of an aneurysm after diagnosis | 20 years | 
| Radiological aneurysm exclusion | Ability to completely and permanently exclude the lesion with the treatment | 20 years | 
| Recurrence | Recurrence or repermeabilisation of the aneurysm after treatment | 20 years | 
| Neo-aneurysm formation | New identification of aneurysm during follow up previously not diagnosed | 20 years | 
| Quality of life (EQ-5D) | regular measurement of quality of life during follow-up | 20 years | 
| Neuropsychological performance | regular measurement of neuropsychological performance (MMSE, dedicated evaluation) | 20 years | 
| Neurological status | regular measurement of the NIHSS during follow-up | 20 years | 
| Cranial nerves status | regular evaluation of cranial nerve function during follow-up | 20 years | 
| Occurence of hydrocephalus | need for internal CSF drainage system implantation | 20 years | 
| Occurence of vasospasm | need for aggressive hypertensive treatment or endo-vascular rescue therapy (IA vasodilator injection, balloon angioplasty) | 20 years |