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Our changing neurointerventional world
  1. Joshua A Hirsch
  1. Correspondence to Dr Joshua A Hirsch, NeuroEndovascular Program, Massachusetts General Hospital, Boston, MA 02114, USA; hirsch{at}snisonline.org

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I'm sitting at the Society of NeuroInterventional Surgery annual meeting in San Francisco. As usual, I am enjoying the wondrous variety of materials that are being presented. Having rotated off the board of directors a number of years back, I find myself able to participate in the sessions in a more robust way than previously. There are new technologies, existing ones that are iteratively improved, emerging concepts for classic diseases, and many other topics that continue to come to the fore.

For the entirety of my career, I've watched neurointerventional (NI) surgery grow in strength, scope, and power. Close to three short decades ago, industry allowed for NI specialists to reproducibly enter the intracranial circulation with a commercially manufactured microcatheter. In 2015 we are celebrating the 25th anniversary of the first detachable coil, the Guglielmi detachable coil—this changed our NI world. A similar seismic shift is occurring after publication of the positive endovascular stroke trials. While these historic moments in our specialty have been intended by design, they have occurred within broader historic changes in healthcare policy that will continue to mold our NI sphere. To some extent, while those policy changes are themselves thoughtfully designed, their power can derive from unintended consequences.

Until recently, the single biggest development in the delivery of US healthcare in the last 50 years was Title 18 of the Social Security Act: the creation of Medicare. Who can forget the iconic image of the former President Harry Truman receiving the first Medicare insurance …

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