Future Directions of Flow Diverter Therapy

The treatment of intracranial aneurysms has undergone a few very significant paradigm shifts in its history. Needless to say, microsurgery and surgical clipping served as the initial basis for successful treatment of these lesions. The pursuit of endovascular therapy subsequently arose from the desire to reduce the invasiveness of therapy. While the first breakthrough arose with Guido Guglielmi's invention of the detachable platinum coil, commercialized flow diverter therapy represents a disruptive therapy with a completely different paradigm for aneurysmal obliteration. This has not only altered the distribution of aneurysmal management strategies, but also opened the gateway to the treatment of previously inoperable lesions. With the basic flow diverter stent technology now considered an integral part of the neurointerventional armamentarium, we now consider what may lay in the future - including potential directions for research with regards to case selection; the location and type of aneurysms which may become routinely treatable; and modifications to the flow diverter, which may increase its utility and safety in terms of size, structural design, and surface modifications.