State-of-the-Art and Future Perspective of Devices for Neuroendovascular Treatment

In this chapter, we discuss the history of devices developed for neuroendovascular therapy, culminating with the state-of-the-art devices in each category. Innovative tools for intracranial access including guide catheters, intermediate catheters, microcatheters, and guidewires which were critical to the development of neurointerventional procedures are addressed first. With the introduction of coil embolization, aneurysms became amenable to minimally invasive treatment. Stents brought the strategy of parent vessel reconstruction to assist coiling of wide neck aneurysms, while disruption of flow at the aneurysm neck to enhance stagnation of blood in the sac enabled treatment of previously untreatable aneurysms, without sacrificing the parent vessel. For revascularization in acute ischemic stroke, mechanical thrombectomy devices were developed for clot removal. Subsequently, advances in polymer and materials technology and engineering breakthroughs in catheter design made it possible to deliver 5 French and 6 French catheters safely and reliably to the middle cerebral artery, thus allowing the promise of simple aspiration thrombectomy to be realized. The future of stent design and the exciting promise of neurointervention are also considered.

Keywords: Aneurysm coiling, coil embolization, flow diverter, intracranial access, mechanical thrombectomy, microcatheter, reperfusion catheter, stent retriever, thrombus revascularization.