This month's supplement of the Journal of NeuroInterventional Surgery highlights three exciting aspects of cerebral aneurysm management and research. Specifically, advances in flow diversion, quantitative aneurysm analysis, and novel applications of established techniques are described in 15 manuscripts by leaders in the endovascular field. These articles not only present novel ideas, they raise provocative questions about the future of aneurysm treatment.

The advent of flow diverting devices and their burgeoning use in the USA have underscored the need for greater understanding of antiplatelet therapies. Complications arising from overdosage, underdosage, and patient resistance are troubling issues that warrant further investigation. To this end, Almandoz et al1 report an analysis of the predictive value of P2Y12 reaction units in determining patients at greatest risk of suffering perioperative thromboembolic and hemorrhagic complications after treatment with the Pipeline device (Covidien Vascular Therapies, Mansfield, Massachusetts, USA). Their determination that P2Y12 reaction units of less than 60 and greater than 240 were predictive of these major perioperative complications sets an objective range within which practitioners can or cannot proceed with their intervention. Tailoring antiplatelet therapy either by modifying an existing medication regimen or by changing medications to achieve values within this range may dramatically reduce the incidence of these potentially devastating events.

The efficacy of antiplatelet therapy is underscored in the article by Shankar et al.2 Despite pre- and postoperative antiplatelet therapy, two patients in their study developed parent artery occlusions after treatment with the SILK flow diverter (Balt Extrusion, Montmorency, France). …