Jildaz Caroff
The WEB aneurysm embolization system (Sequent Medical, Aliso Viejo, California) is a promising device dedicated to the treatment of challenging wide-neck intracranial bifurcation aneurysms. While this device is still under evaluation, preliminary results are promising.
In the department of Professor Jacques Moret in Paris (Neuri – Brain Vascular Center), we have been using C-arm VasoCT (Philips Healthcare, Best, The Netherlands) for many years, mainly as a unique everyday way to assess the correct placement of intracranial stents, especially flow-diverter types.
From this experience we have applied this technique to the WEB system — first for safety, because the visibility of the WEB is poor with conventional angiography compared with coils. We believe that VasoCT is the best way to obtain a precise evaluation of the WEB sizing and its relation to the parent vessel before delivery. Such information is fundamental to safely use the WEB device and to avoid potential terrible thromboembolic complications.
Second, VasoCT is also the most precise imaging tool to assess occlusion rates during follow-up. This optimal assessment also appears essential to us during the evaluation process of a new embolization device. Thus, we have proposed a modified Montreal occlusion scale based on VasoCT data, and it has been published within another series of ruptured aneurysms treated with the WEB.1