Historical Perspectives

Endovascular treatment of intracranial aneurysms was first described in the early 1970s in the pioneering paper of Serbinenko. He treated aneurysms with detachable balloons that were positioned in the parent artery or in the aneurysm lumen itself through a microcatheter (1,2). In 1991, Guglielmi et al. (3,4) described the endovascular occlusion of intracranial aneurysms using electrolytic detachable platinum coils (Target Therapeutics/Boston Scientific). The Guglielmi detachable coils (GDCs) could be introduced through a micro-catheter into the aneurysm lumen and detached from a stainless steel microwire by an electrical current. In 1995 the device was approved by the Food and Drug Administration (FDA) and has become widely used in patients with ruptured and unruptured intracranial aneurysms. The GDC technology has evolved ever since, and as clinical experience with this technique has accumulated, it has become the method of choice for the endovascular treatment of intracranial aneurysms. Improved microcatheter and microwire designs have greatly facilitated intracranial intravascular navigation, allowing catheterization of distal aneurysms. Until recently, endovascular treatment in the Unites States was reserved for aneurysms not amenable to surgical clipping. In August 2003, the FDA granted approval to market GDC for the treatment of all brain aneurysms. Continuous technical advances and increasing clinical experience with endo-vascular techniques as well as its minimal invasiveness have made endovascu-lar treatment an attractive alternative, even in patients who could be treated by conventional neurosurgical clipping.

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