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The road not taken
  1. Italo Linfante
  1. Correspondence to Dr Italo Linfante, Department of Endovascular Neurosurgery, Interventional Neuroradiology, Herbert Wertheim College of Medicine, Florida International University, Baptist Cardiac and Vascular Institute, 8900 North Kendal Drive, Miami, FL 33176, USA; linfante.italo{at}; italol{at}

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Two roads diverged in a yellow wood, And sorry I could not travel both And be one traveler, long I stood And looked down one as far as I could To where it bent in the undergrowth… … I shall be telling this with a sigh Somewhere ages and ages hence: Two roads diverged in a wood, and I- I took the one less traveled by, And that has made all the difference. Robert Lee Frost (San Francisco, March 26, 1874—Boston, January 29, 1963)

In 1991 Guido Guglielmi et al in the first of two manuscripts reported the basic functioning of detachable coils.1 In the second article, the authors demonstrated aneurysmal thrombosis in 70–100% of their 15 patients treated with this new technology.2 On 8 September 1995, the Food and Drug Administration approved commercial sale of the Guglielmi detachable coils (GDC). Unquestionably, GDC started a revolution in neurosurgery by changing forever the way we treat cerebral aneurysms. In 2002, the Lancet published the results of International Subarachnoid Aneurysm Trial (ISAT).3 The absolute risk reduction for dependency or death in the endovascular group was 6.9% and the relative risk reduction was 22.6%. At 1 year, the absolute risk reduction was 7.4%. The early survival advantage of patients treated with endovascular embolization compared with …

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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.