We read with interest the article by Pierot et al1 regarding the results of the WEBCAST 2 study. We do, however, take issue with the statement that it confirms the “high” efficacy of the device. They reported a complete occlusion rate of 54% and “adequate” occlusion, including neck remnants, in 80% of 50 aneurysms (93% unruptured). The complete occlusion rate from neurosurgical clipping in the largest randomized controlled trials of coiling versus clipping of ruptured aneurysms was 96%.2,3 A meta-analysis of clipping of unruptured aneurysms showed a complete occlusion rate of 92%.4 Although the decision to proceed with endovascular therapy in WEBCAST was made by a multidisciplinary team, it may be wise to temper one's enthusiasm for novel endovascular devices when open neurosurgical treatment may offer a truly “high” level of efficacy.
References
- © 2017 by American Journal of Neuroradiology
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