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New devices and techniques
Case series
First-in-human, real-time artificial intelligence assisted cerebral aneurysm coiling: a preliminary experience
  1. Osamu Masuo1,
  2. Yuya Sakakura2,
  3. Yoshiaki Tetsuo1,
  4. Kana Takase1,
  5. Shun Ishikawa1,
  6. Kenichi Kono3,4
    1. 1Department of Neuroendovascular surgery, Yokohama Municipal Citizen's Hospital, Yokohama, Kanagawa, Japan
    2. 2Department of Neurosurgery, NTT Medical Center Tokyo, Shinagawa-ku, Tokyo, Japan
    3. 3Department of Neurosurgery, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
    4. 4iMed Technologies, Bunkyo-ku, Tokyo, Japan
    1. Correspondence to Dr Yuya Sakakura, Department of Neurosurgery, NTT Medical Center Tokyo, Shinagawa-ku, Tokyo, Japan; yuya.sakakura{at}gmail.com

    Abstract

    Background Neuroendovascular procedures require careful and simultaneous attention to multiple devices on multiple screens. Overlooking unintended device movements can result in complications. Advancements in artificial intelligence (AI) have enabled real-time notifications of device movements during procedures. We report our preliminary experience with real-time AI-assisted cerebral aneurysm coiling in humans.

    Methods A real-time AI-assistance software (Neuro-Vascular Assist, iMed technologies, Tokyo, Japan) was used during coil embolization procedures in nine patients with an unruptured aneurysm. The AI system provided real-time notifications for ‘coil marker approaching’, ‘guidewire movement’, and ‘device entry’ on biplane fluoroscopic images. The efficacy, accuracy, and safety of the notifications were evaluated using video recordings.

    Results The AI system functioned properly in all cases. The mean number of notifications for coil marker approaching, guidewire movement, and device entry per procedure was 20.0, 3.0, and 18.3, respectively. The overall precision and recall were 92.7% and 97.2%, respectively. Five of 26 true positive guidewire notifications (19%) resulted in adjustment of the guidewire back toward its original position, indicating the potential effectiveness of the AI system. No adverse events occurred.

    Conclusions The software was sufficiently accurate and safe in this preliminary study, suggesting its potential usefulness. To the best of our knowledge, this is the first reported use of a real-time AI system for assisting cerebral aneurysm coiling in humans. Large scale studies are warranted to validate its effectiveness. Real-time AI assistance has significant potential for future neuroendovascular therapy.

    • Angiography
    • Coil
    • Aneurysm
    • guidewire
    • Technology

    https://doi.org/10.1136/jnis-2024-021873

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      Footnotes

      • X @CeoImed

      • Contributors OM and YS contributed equally to this work and should be considered as co-first authors. KK conceived the idea of the study and supervised its conduct. YS and KK drafted the original manuscript. OM, YT, KT, and SI were involved in the treatment of the patients in the case series. All authors reviewed the manuscript draft and critically revised it. All authors approved the final version of the manuscript for publication.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests YS received payment from iMed Technologies. KK is a CEO and holds shares in iMed Technologies. OM received a lecture fee from Daiichi Sankyo Company, Limited.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.