Developments

Surgical clipping had been the established modality of treatment for ruptured and unruptured cerebral aneurysms until 1991, when GDC embolization was introduced as an alternative method for treating selected aneurysm patients. Endovascular treatment has since evolved based on enhanced clinical experience and technologic improvements. Selection of aneurysms appropriate for coiling has improved, and over the last decade, the range of coils was increased, with the availability of multidimensional coils that allow safer initial coil placement and the development of softer coils (17).

Endovascular therapy is now a well-established treatment modality for a variety of cerebrovascular central nervous system disorders. Dramatic improvements in the field of neu-roendovascular surgery have been made, including the development of techniques that provide treatment options for conditions previously thought to be untreatable.

Over the past 15 years, flexible microcatheters have been developed, which allow navigation to the distal intracranial and spinal circulation by percutaneous cannulation of the femoral artery or vein. Techniques to embolize aneurysms, including occlusion of parent arteries and endosaccular packing, have evolved to treat previously inoperable aneurysms. Advances in coil technology have also focused on coating applications that modify the biologic reaction to the coil surface. Recent advances have been made in gene therapy, which might allow for the enhancement of direct gene transfer in situ by coated coils (18). Ongoing device developments and technologic advances and refinements continue to revolutionize the field of neuroendo-vascular therapy. Combined with a better clinical understanding of disease pathophysiology, minimally invasive neuroendovascular techniques are rapidly providing treatment options for a wide spectrum of neurologic diseases (19).

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