Endovascular therapy of intracranial aneurysms.

The use of endovascular techniques, mostly detachable balloons, for treatment of intracranial aneurysms has progressed since balloons were first used in neuroendovascular therapy [1]. Although the use of detachable balloons for treating intracranial fistulas while preserving the parent artery quickly became the treatment of choice, especially for traumatic carotid-cavernous fistulas , balloon therapy of intracranial aneurysms has lagged behind. In our own early experience, about 1 0 years ago, in using detachable balloons to treat aneurysms while preserving the parent arteries, we encountered various problems [2], and therefore for many years we reserved balloon treatment for occlusion of parent arteries, which is a simple and safe although less elegant technique for treating unclippable aneurysms [2, 3] . At the same time, Victor Shcheglov in Kiev has exercised great technical skill, ingenuity, and remarkable clinical judgment in using detachable balloons for the primary treatment of all patients with intracranial aneurysms who are referred to the Ukrainian Neurosurgical Research Institute [4]. Among Western neurovascular therapists, the group of neuroradiologists in San Francisco have been the prime innovators for some years in using balloons to treat intracranial aneurysms with preservation of the parent arteries [5-7] . They have been joined recently by others, most notably Jacques Moret in Paris. Higashida et al. [7] provide a remarkable summary of their series of patients with intracranial aneurysms treated by detachable balloon while preserving the parent arteries. They have restricted their cases to patients who were not candidates for aneurysmal clipping by the neurosurgeons with whom they work. They have, therefore, used balloons in a rather difficult group, selected from patients with a high-risk disease. They must be commended for their innovation, the