1naresh2naresh<pre>Array
(
    [urn:ac.highwire.org:guest:identity] => Array
        (
            [runtime-id] => urn:ac.highwire.org:guest:identity
            [type] => guest
            [service-id] => ajnr-ac.highwire.org
            [access-type] => FreeToRead
            [privilege] => Array
                (
                    [urn:ac.highwire.org:guest:privilege] => Array
                        (
                            [runtime-id] => urn:ac.highwire.org:guest:privilege
                            [type] => privilege-set
                            [privilege-set] => GUEST
                        )

                )

            [credentials] => Array
                (
                    [method] => guest
                )

        )

    [19a3cf7a-36b0-41c9-a1b6-b534d6614391] => Array
        (
            [runtime-id] => 19a3cf7a-36b0-41c9-a1b6-b534d6614391
            [type] => toll-free-key
            [service-id] => ajnr-ac.highwire.org
            [access-type] => FreeToRead
            [privilege] => Array
                (
                    [83b0290d-64d4-4b01-b446-35a6bce19e0f] => Array
                        (
                            [runtime-id] => 83b0290d-64d4-4b01-b446-35a6bce19e0f
                            [type] => toll-free-key
                        )

                )

            [credentials] => Array
                (
                    [method] => toll-free-key
                    [value] => tf_ipsecsha;5f6c7286b14baebe97a2a3b036748517492eaeed
                )

        )

)
1naresh2naresh<pre>Array
(
    [urn:ac.highwire.org:guest:identity] => Array
        (
            [runtime-id] => urn:ac.highwire.org:guest:identity
            [type] => guest
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [urn:ac.highwire.org:guest:privilege] => Array
                        (
                            [runtime-id] => urn:ac.highwire.org:guest:privilege
                            [type] => privilege-set
                            [privilege-set] => GUEST
                        )

                )

            [credentials] => Array
                (
                    [method] => guest
                )

        )

    [0909c9cd-5427-4d5e-8070-af146eaa909e] => Array
        (
            [runtime-id] => 0909c9cd-5427-4d5e-8070-af146eaa909e
            [type] => toll-free-key
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [2639364a-6492-407d-b4d6-e713e1ff761f] => Array
                        (
                            [runtime-id] => 2639364a-6492-407d-b4d6-e713e1ff761f
                            [type] => toll-free-key
                        )

                )

            [credentials] => Array
                (
                    [method] => toll-free-key
                    [value] => tf_ipsecsha;5f6c7286b14baebe97a2a3b036748517492eaeed
                )

        )

)
Safety and Efficacy of Aneurysm Treatment with the WEB
======================================================

* D.M. Pelz
* S.P. Lownie

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. Pierot L, Gubucz I, 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
    
    [Abstract/FREE Full Text](http://www.ajnr.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo5OiIzOC82LzExNTEiO3M6NDoiYXRvbSI7czoyMToiL2FqbnIvMzgvMTIvRTEwOS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

2.  2. Spetzler RF, McDougall CG, 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
    
    [CrossRef](http://www.ajnr.org/lookup/external-ref?access_num=10.3171/2014.9.JNS141749&link_type=DOI) 
    
    [PubMed](http://www.ajnr.org/lookup/external-ref?access_num=26115467&link_type=MED&atom=%2Fajnr%2F38%2F12%2FE109.atom) 

3.  3. Campi A, Ramzi N, 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
    
    [Abstract/FREE Full Text](http://www.ajnr.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6OToic3Ryb2tlYWhhIjtzOjU6InJlc2lkIjtzOjk6IjM4LzUvMTUzOCI7czo0OiJhdG9tIjtzOjIxOiIvYWpuci8zOC8xMi9FMTA5LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

4.  4. Kotowski M, Naggara O, 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
    
    [Abstract/FREE Full Text](http://www.ajnr.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiam5ucCI7czo1OiJyZXNpZCI7czo3OiI4NC8xLzQyIjtzOjQ6ImF0b20iO3M6MjE6Ii9ham5yLzM4LzEyL0UxMDkuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

*   © 2017 by American Journal of Neuroradiology