The new millennium brings with it tremendous advances in technology and information sharing. Various medical, surgical, and engineering specialities are becoming more focused, thus enabling experts in these fields to gain insight and understanding previously unappreciated by those who came before us. Economic and technologic evolution will eliminate some of the drawbacks of endovascular therapy, such as persistent neck remnants. It is likely that drug delivery systems exist that would allow maximal benefit with little or no systemic adverse effects. It is likely that devices are available that could minimize various procedural complications. We as future neurosurgeons must persist in the quest to find collaborations that will promote cross-fertilization and cross-pollination among cardiologists, neurosurgeons, physicists, radiologists, neurologists, engineers, and other scientists so that the technology can be translated to reality. It is clear that, in time, transcatheter techniques will replace many operations for the treatment of cerebrovascular pathologies. Let us not allow ourselves the luxury of time.