Advertisement

AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

LetterLetter

Safety and Efficacy of Aneurysm Treatment with the WEB

D.M. Pelz and S.P. Lownie
American Journal of Neuroradiology December 2017, 38 (12) E109; DOI: https://doi.org/10.3174/ajnr.A5387

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

  1. 1.
    2. Pierot L,
    3. Gubucz I,
    4. Buhk JH, et al
    . Safety and efficacy of aneurysm treatment with the WEB: results of the WEBCAST 2 study. AJNR Am J Neuroradiol 2017;38:1151–55 doi:10.3174/ajnr.A5178 pmid:28450432
  2. 2.
    2. Spetzler RF,
    3. McDougall CG,
    4. Zabramski JM, et al
    . The Barrow Ruptured Aneurysm Trial: 6-year results. J Neurosurg 2015;123:609–17 doi:10.3171/2014.9.JNS141749 pmid:26115467
  3. 3.
    2. Campi A,
    3. Ramzi N,
    4. Molyneux AJ, et al
    . Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial (ISAT). Stroke 2007;38:1538–44 doi:10.1161/STROKEAHA.106.466987 pmid:17395870
  4. 4.
    2. Kotowski M,
    3. Naggara O,
    4. Darsaut TE, et al
    . Safety and occlusion rates of surgical treatment of unruptured intracranial aneurysms: a systematic review and meta-analysis of the literature from 1990 to 2011. J Neurol Neurosurg Psychiatry 2013;84:42–48 doi:10.1136/jnnp-2011-302068 pmid:23012447
Advertisement