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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">L. Pierot</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">December 2017,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">38 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(12) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">E110; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A5416 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-57360--61787441623" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">L. Pierot </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Department of Neuroradiology
Hôpital Maison-Blanche
CHU Reims
Université Reims-Champagne-Ardenne
Reims, France</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=L.%2BPierot%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Pierot%20L&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AL.%2BPierot%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-2523-4909" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for L. Pierot</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view "><span class="highwire-journal-article-marker-start"></span><p id="p-1">We have read with great interest the letter of Pelz and Lownie, and we are grateful for their interesting comments regarding our paper on the WEBCAST-2 study.<sup><a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1</a></sup> We wish to make the following comments in response.</p><ol class="list-ord " id="list-1"><li id="list-item-1"><p id="p-2">Because Pelz and Lownie are only challenging the “high” efficacy of WEB treatment, it probably implies that they concur with the high safety profile of the WEB device reported in WEBCAST-2. This is the primary concern when dealing with aneurysm treatment, and all published results of good clinical practice studies evaluating WEB (WEBCAST, French Observatory, and WEB-IT) have indeed confirmed similar high safety results: low morbidity (between 0.7% and 3.2%) and no mortality at 1 month.<sup><a id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2</a><a id="xref-ref-3-1" class="xref-down-link" href="#ref-3"><span>⇓</span></a>–<a id="xref-ref-4-1" class="xref-bibr" href="#ref-4">4</a></sup> For reference, the meta-analysis cited by Pelz and Lownie reports mortality of 1.7% for surgical treatment of unruptured aneurysms, with the rate of unfavorable outcome at 6.7%.<sup><a id="xref-ref-5-1" class="xref-bibr" href="#ref-5">5</a></sup></p></li><li id="list-item-2"><p id="p-3">Pelz and Lownie are probably right when they write that “high” efficacy might not be the appropriate wording to qualify WEBCAST-2 anatomical results. Still, the rate of adequate occlusion at 1 year is 80.0%, consistent with observations from other WEB good clinical practice studies.<sup><a id="xref-ref-2-2" class="xref-bibr" href="#ref-2">2</a>,<a id="xref-ref-3-2" class="xref-bibr" href="#ref-3">3</a></sup> Although we know that neck remnant is rarely associated with rupture or rerupture, adequate occlusion is really what matters once safety is confirmed. It is also important to point out that patients with wide-neck bifurcation aneurysms—the target population of the WEBCAST-2 study—represent a challenging and difficult-to-treat population, regardless of the treatment technique. We actually agree that long-term follow-up is needed to properly evaluate the stability of aneurysm treatment and claim “high” efficacy. Long-term follow-up has been obtained in a small, retrospective European series, but the most important data will come from the good clinical practice studies where 5 years' follow-up is foreseen.<sup><a id="xref-ref-6-1" class="xref-bibr" href="#ref-6">6</a></sup></p></li><li id="list-item-3"><p id="p-4">Interestingly, Pelz and Lownie are comparing the efficacy of WEB treatment with surgical treatment. Kotowski et al<sup><a id="xref-ref-5-2" class="xref-bibr" href="#ref-5">5</a></sup> report 2 interesting facts in their meta-analysis: aneurysm occlusion data are missing for 82.2% of all clipped aneurysms in the analyzed series, and there was no long-term follow-up available. With that in mind, can we scientifically consider surgical treatment “effective” from a long-term anatomic standpoint?</p></li></ol><div class="section ref-list" id="ref-list-1"><h2 class="">References</h2><ol class="cit-list ref-use-labels"><li><span class="ref-label">1.</span><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1. in text" id="ref-1">↵</a><div class="cit ref-cit ref-journal" id="cit-38.12.E110.1" data-doi="10.3174/ajnr.A5178"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Pierot</span>  <span class="cit-name-given-names">L</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Gubucz</span>  <span class="cit-name-given-names">I</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Buhk</span>  <span class="cit-name-given-names">JH</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Safety and efficacy of aneurysm treatment with the WEB: results of the WEBCAST-2 study</span>. <abbr class="cit-jnl-abbrev">AJNR Am J Neuroradiol</abbr> <span class="cit-pub-date">2017</span>;<span class="cit-vol">38</span>:<span class="cit-fpage">1151</span>–<span class="cit-lpage">55</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.3174/ajnr.A5178</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>28450432</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo5OiIzOC82LzExNTEiO3M6NDoiYXRvbSI7czoyMToiL2FqbnIvMzgvMTIvRTExMC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">2.</span><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2. in text" id="ref-2">↵</a><div class="cit ref-cit ref-journal" id="cit-38.12.E110.2" data-doi="10.3171/2015.2.JNS142634"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Pierot</span>  <span class="cit-name-given-names">L</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Costalat</span>  <span class="cit-name-given-names">V</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Moret</span>  <span class="cit-name-given-names">J</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Safety and efficacy of aneurysm treatment with WEB: results of the WEBCAST study</span>. <abbr class="cit-jnl-abbrev">J Neurosurg</abbr> <span class="cit-pub-date">2016</span>;<span class="cit-vol">124</span>:<span class="cit-fpage">1250</span>–<span class="cit-lpage">56</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.3171/2015.2.JNS142634</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>26381253</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.3171/2015.2.JNS142634&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=26381253&amp;link_type=MED&amp;atom=%2Fajnr%2F38%2F12%2FE110.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">3.</span><a class="rev-xref-ref" href="#xref-ref-3-1" title="View reference 3. in text" id="ref-3">↵</a><div class="cit ref-cit ref-journal" id="cit-38.12.E110.3" data-doi="10.3174/ajnr.A4578"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Pierot</span>  <span class="cit-name-given-names">L</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Moret</span>  <span class="cit-name-given-names">J</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Turjman</span>  <span class="cit-name-given-names">F</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">WEB treatment of intracranial aneurysms: clinical and anatomical results in the French Observatory</span>. <abbr class="cit-jnl-abbrev">AJNR Am J Neuroradiol</abbr> <span class="cit-pub-date">2016</span>;<span class="cit-vol">37</span>:<span class="cit-fpage">655</span>–<span class="cit-lpage">59</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.3174/ajnr.A4578</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>26514608</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo4OiIzNy80LzY1NSI7czo0OiJhdG9tIjtzOjIxOiIvYWpuci8zOC8xMi9FMTEwLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">4.</span><a class="rev-xref-ref" href="#xref-ref-4-1" title="View reference 4. in text" id="ref-4">↵</a><div class="cit ref-cit ref-journal" id="cit-38.12.E110.4" data-doi="10.1136/neurintsurg-2016-012841"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Fiorella</span>  <span class="cit-name-given-names">D</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Molyneux</span>  <span class="cit-name-given-names">A</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Coon</span>  <span class="cit-name-given-names">A</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Demographic, procedural, and 30-day safety results from the WEB Intra-saccular Therapy Study (WEB-IT)</span>. <abbr class="cit-jnl-abbrev">J Neurointerv Surg</abbr> <span class="cit-pub-date">2017</span> 
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<span class="cit-day">17</span>. <span class="cit-comment">[Epub ahead of print]</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1136/neurintsurg-2016-012841</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>28096478</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MTE6Im5ldXJpbnRzdXJnIjtzOjU6InJlc2lkIjtzOjk6IjkvMTIvMTE5MSI7czo0OiJhdG9tIjtzOjIxOiIvYWpuci8zOC8xMi9FMTEwLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">5.</span><a class="rev-xref-ref" href="#xref-ref-5-1" title="View reference 5. in text" id="ref-5">↵</a><div class="cit ref-cit ref-journal" id="cit-38.12.E110.5" data-doi="10.1136/jnnp-2011-302068"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Kotowski</span>  <span class="cit-name-given-names">M</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Naggara</span>  <span class="cit-name-given-names">O</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Darsaut</span>  <span class="cit-name-given-names">TE</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Safety and occlusion rates of surgical treatment of unruptured intracranial aneurysms: a systematic review and meta-analysis of the literature from 1990 to 2011</span>. <abbr class="cit-jnl-abbrev">J Neurol Neurosurg Psychiatry</abbr> <span class="cit-pub-date">2013</span>;<span class="cit-vol">84</span>:<span class="cit-fpage">42</span>–<span class="cit-lpage">48</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1136/jnnp-2011-302068</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>23012447</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiam5ucCI7czo1OiJyZXNpZCI7czo3OiI4NC8xLzQyIjtzOjQ6ImF0b20iO3M6MjE6Ii9ham5yLzM4LzEyL0UxMTAuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">6.</span><a class="rev-xref-ref" href="#xref-ref-6-1" title="View reference 6. in text" id="ref-6">↵</a><div class="cit ref-cit ref-journal" id="cit-38.12.E110.6" data-doi="10.3174/ajnr.A4445"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Pierot</span>  <span class="cit-name-given-names">L</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Klisch</span>  <span class="cit-name-given-names">J</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Liebig</span>  <span class="cit-name-given-names">T</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">WEB-DL endovascular treatment of wide-neck bifurcation aneurysms: long-term results in a European series</span>. <abbr class="cit-jnl-abbrev">AJNR Am J Neuroradiol</abbr> <span class="cit-pub-date">2015</span>;<span class="cit-vol">36</span>:<span class="cit-fpage">2314</span>–<span class="cit-lpage">19</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.3174/ajnr.A4445</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>26228882</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czoxMDoiMzYvMTIvMjMxNCI7czo0OiJhdG9tIjtzOjIxOiIvYWpuci8zOC8xMi9FMTEwLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li></ol></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2017 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 38</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 12 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Dec 2017 </div></div>
      
      
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Dec 2017, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">38 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(12) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">E110; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A5416 </span></div>
  
  
  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">L.</span> <span class="nlm-surname">Pierot</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Dec 2017, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">38 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(12) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">E110; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A5416 </span></div>
  
  
  
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