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.
