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The beginning and the evolution of the endovascular treatment of intracranial aneurysms: from the first catheterization of brain arteries to the new stents
  1. G Guglielmi
  1. Correspondence to
    Professor G Guglielmi, Department of Neurosciences, University of Rome “La Sapienza”, Piazza Mazzini 27, 00195 Rome, Italy; guidogdc{at}yahoo.com

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The field of endovascular neurosurgery was paved by the work of a few creative “pioneers” who invented new delivery systems and new embolic agents capable of treating vascular diseases of the brain, such as aneurysms. Knowledge of the historical basis, of the foundations, of our discipline is always beneficial: it allows appreciation of the work of the “fathers” and gives a sense of continuity in science. It also gives doctors in training the fundamental background information. And, why not, history is also entertaining!

The history of the endovascular treatment of brain aneurysms can be divided into three periods or eras: the pre-balloons era, the balloons era and the coils era.

The pre-balloons era

We can say that, as of today (2009), our discipline of endovascular neurosurgery–interventional neuroradiology is 45 years old!

In fact, Luessenhop and Velasquez performed the first catheterization of intracranial vessels in 1964.1 They invented a system capable of entering brain arteries with a silastic microcatheter, via the surgically exposed external carotid artery in the neck. They even performed endovascular temporary balloon occlusion of the neck of a posterior communicating artery aneurysm. They prophetically predicted that “catheterization as well as embolization of the intracranial arteries may have therapeutic usefulness, particularly in the treatment of aneurysms and arteriovenous malformations”.

In the mid-1960s, Frei, Yodh, Driller, Montgomery, Cares and Hilal utilized a new microcatheter called para-operational device (POD).2 3 4 5 6 7 The proximal portion was made of polyethylene and the distal portion of soft silicone rubber. The distal section measured only 1.3 mm in outer diameter and was 7 cm in length. Embedded in the tip of the silicone tubing was a micromagnet which measured 1 mm in diameter. External magnetic fields, both continuous and alternating, could be applied to pull and bend the micromagnet tipped microcatheter (by the continuous field) and …

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