Evidence and Phronesis of Intracranial Aneurysms

Abstract

  Evidence-based medicine does not refer to the exclusion of scientifically unproven medical practices but to the action guidelines used for optimization of individualized treatment through comprehensive evaluation of the three elements of “evidence, ” “experience and knowledge of specialists,” and “patient values.” This concept represents Aristotle's theory of phronesis. Correct application of evidence requires an accurate understanding of not only the results of clinical studies on which the evidence is based but also on the study design, patient background, evaluation methods, and historical background. The International Subarachnoid Aneurysm Trial and Barrow Ruptured Aneurysm Trial, which compared surgical outcomes of clipping and coiling for ruptured intracranial aneurysms (IAs) and the Unruptured Cerebral Aneurysm Study Japan, which describes the natural history of unruptured IAs in the Japanese population include evidence-based trials of IAs. Results of basic research using animal models, radiomics based on imaging data, and research using artificial intelligence are expected to establish new evidence in future.