Future Direction of Neuro-Endovascular Therapy : Innovation in Device Development and Improvement

Abstract

  The continued development and improvement of devices is the most important factor to advance neuro-endovascular therapy. The endovascular treatment of intracranial aneurysms started with detachable coil technology and has been further developed with adjunctive device technology, including the hyper compliant balloon and the neck bridge stent. These technologies are all focused on tightly packing aneurysm with coils. The flow diverter operates on a totally different theory, whereby blood flow into the aneurysm is regulated with a fine mesh stent to achieve occlusion and shrinkage of the aneurysm. The Pipeline Flex was approved in 2015 and we have just started to evaluate this new technology in Japan. However, there will still remain some aneurysms that cannot be cured by the flow diverter. To treat these, we will have a new range of innovative devices, the PulseRider, WEB, Medina and others in the near future. In the field of carotid disease, carotid artery stenting has already overtaken endarterectomy in Japan with its acceptable results and patient desire for a less invasive modality. But, periprocedural ischemic stroke is still more frequent in CAS. A new generation of micro-mesh stents will hopefully resolve this problem beginning with the CASPER approved study just started in Japan. Average risk CEA patients can now enroll in this study and. Going forward, many new innovative devices will continue to be deployed in the field of neuro-endovascular therapy. As always, we should safeguard both their appropriate use and patient safety in order to best contribute to the development of this field.