Professor Bulters is a consultant neurosurgeon specialising in vascular conditions. His group’s main themes are risk prediction for unruptured intracranial aneurysms and reducing brain injury from haemoglobin after subarachnoid haemorrhage.
He is past president of the British Neurovascular Group, has held grants from the NIHR, EPSRC, Innovate UK, MRC, European Union, RCS and several medical charities and has been chief and principal investigator for many randomised trials of new drugs, cell therapies and surgical techniques. 
His interest in unruptured aneurysms focuses on risk prediction, new imaging techniques to stratify risk, including vessel wall imaging and dynamic contrast enhanced imaging, and the influence of modifiable risk factors including aspirin, blood pressure and cholesterol.

Risk of Aneurysm Rupture study – rationale and opportunities

Unruptured intracranial aneurysms (UIA) are common. However, only some subsequently rupture. Prophylactic treatment is possible but reserved for those with a rupture risk high enough to justify this. The problem is that our estimates of risk are not accurate enough, and do not stratify patients into sufficiently high and low risk groups, to base these treatment decisions on.
The best natural history data comes from the PHASES study. This has not been validated, and given the heterogeneity in the populations, methods and biases of the constituent studies, there is a need to do so. There are also many predictors not considered in PHASES, and PHASES is based on short term follow up (mostly 1 year) with little data on long term rates relevant to patients. We therefore designed the Risk Of Aneurysm Rupture (ROAR) study with the aims to: 1) test the accuracy of PHASES, 2) evaluate additional predictors, 3) assess long-term rupture rates.
ROAR is a longitudinal multicentre study that identifies patients with UIA in neurosurgery units and determines rupture events using national databases of hospital admissions and deaths. This design enables long term follow-up in a large cohort of 20,000 patients (11,000 to date). 
In this presentation we will describe the design of ROAR and discuss the opportunities to identify different imaging markers of risk of rupture provided by a cohort that is expected to identify several hundred aneurysms with baseline MRA that subsequently rupture.