Which innovations in interventional neuroradiology have shaped your career?

The embolization of vascular malformations at cerebral, spinal and maxillofacial levels which has changed rapidly. Throughout my (26 years and more!) of being a specialist in neurointervention, I have seen the incredible evolution in techniques and treatment strategies for these diseases. This has allowed us to understand the haemodynamics and severity of them much better, thus allowing us to be more precise in the indications for treatment.

Who were your mentors in the field and what do you still remember from their wisdom?

I had three mentors: At the beginning of my career in Buenos Aires (1980), my chairman, professor Armando Basso (past president of the World Federation of Neurological Surgeons), was the one who told me about the development of this new specialty. He said: "There is a rapidly developing new specialty, called interventional neuroradiology, and due to how it is evolving, I think it will replace many neurosurgical procedures in the future. So I think that you, being young, might be interested in it, and then decide your future, either as a traditional neurosurgeon or as an endovascular neurosurgeon". He was also the one who gave me the possibility of training with my second mentor Professor Jacques Theron at the University Medical Center in Caen, France, who taught me about this speciality from scratch. Prof. Theron's constant evolution and his continuing trend towards innovation stems from his superior intelligence and these qualities in him have always held my attention. Another of his qualities is the ability to simplify techniques, which originally seemed very complicated. Obviously, this means a power of understanding and capability out of the ordinary. After seven years with Prof Theron and then two years working in Argentina along with Dr Pedro Lylyk, I could finally work in the Lariboisiére Hospital in Paris, France, with the physician who became my third mentor, and in some ways the architect of my future development in both care and university 1evels: Professor Jean Jacques Merland. From him, I learned the techniques of embolization of spinal and cerebral vascular malformations, as well as a balanced way of thinking against the disease. Most importantly, I learned humility, prudence and respect for the patient and his environment.

As a young doctor, do you remember a moment in interventional neuroradiology when you thought, “This is truly amazing”?

The fact that impressed me the most as a young neuroradiologist was seeing how a microcatheter could navigate at the intracerebral level, reaching the most unimaginable areas- This opened endless therapeutic possibilities through these microcatheters, and allowed me to imagine a future full of challenges both from the assistential point of view as well as research.

In the last 10 years or neurointervention, in your opinion, what have been the most defining randomised controlled trials for the specialty?

Randomised studies that have had most influence in our specialty have been the ISAT from the positive point of view for endovascular treatment of intracranial aneurysms, and CAVATAS in the negative point of view, for stopping something that I think will be the undisputed future treatment of carotid stenosis that is angioplasty and stenting in the endovascular way.

Can you describe a memorable case and how interventional neuroradiology came to the rescue?

In 1992, while working at the Lariboisière Hospital, we had a call from the operating room of ENT, because they could not control a bleeding caused by a juvenile angiofibroma, which had linked the branches of both external carotid arteries, eliminating the possibility of embolization through this way. The tumour was supplied by anastomotic branches from both vertebral and both internal carotid arteries. The patient was entering into an hypovolemic shock, and at that moment we had the idea to make a direct percutaneous puncture to the tumour, identifying reflux of blood through the needle. At that time, I decided to inject contrast through the needle, and observed by fluoroscopy that the contrast circulated within the tumour, and washed out, with a proper drain through the draining tumoural veins. It was then that we decided to embolize the tumour through the needle, injecting glue and watching how the embolic substance was distributed in the tumour capillary bed, and after several injections produced devascularisation of the entire tumour The patient was haemodynamically stabilised, and then the tumour could be completely excised. That day, the embolization technique of hypervascular tumours by direct puncture was developed.