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Before the era of mechanical thrombectomy for acute stroke, intracranial aneurysms were the major concern in endovascular surgery practice and research. Technology has been a key driver of the evolution of our field and the introduction of detachable GDC coils in 1992 can be considered as the birth of this new neuro-interventional discipline.1 Maturity came when the ISAT study, using an evidence-medicine approach, showed that endovascular therapy was equivalent to, or even better than, open surgery2.
However, the limits of the endovascular discipline were obvious and they were often highlighted in the neurosurgical literature. These limits included the following issues: the majority of coiled aneurysms were not completely occluded at follow-up; up to one fifth …
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.