title: Role of C-arm VasoCT in the use of endovascular WEB flow disruption in intracranial aneurysm treatment.
abstract: OBJECTIVE
  The WEB aneurysm embolization system is still under evaluation but seems to be a promising technique to treat wide-neck bifurcation aneurysms. However, this device is barely visible using conventional DSA; thus, high-resolution contrast-enhanced flat panel detector CT (VasoCT) may be useful before detachment to assess the sizing and positioning of the WEB. The purpose of this study was to evaluate the interest of VasoCT during WEB procedures.
  
  
  METHODS
  From March 2012 to July 2013, twelve patients (10 women and 2 men; age range, 44-55 years) were treated for 13 intracranial aneurysms with the WEB device. DSA and VasoCT were used and compared to depict any protrusion of the device in parent arteries before detachment. Two neuroradiologists reviewed each VasoCT scan, and the quality was graded on a subjective quality scale.
  
  
  RESULTS
  The mesh of the WEB was very well-depicted in all cases, allowing a very good assessment of its deployment. Device protrusion was clearly detected with VasoCT in 5 cases, leading to WEB repositioning or size substitution. During follow-up, VasoCT also allows good assessment of eventual residual blood flow inside the aneurysm or the WEB device.
  
  
  CONCLUSIONS
  Unlike DSA, VasoCT is an excellent tool to assess WEB deployment and positioning. In our experience, it allowed a precise evaluation of the WEB sizing and its relation to the parent vessel. Such information very likely enhances the ability to safely use this device, avoiding potential thromboembolic events in cases of protrusion in the parent arteries.
authors: From the Department of Interventional Neuroradiology (J.C., C.M., H.N., L.I., N.B., J.M., L.S.), Beaujon Medical Centre, Clichy, France Jildaz.caroff@gmail.com.
authors: J
authors: J
authors: Caroff
authors: From the Department of Interventional Neuroradiology (J.C., C.M., H.N., L.I., N.B., J.M., L.S.), Beaujon Medical Centre, Clichy, France.
authors: C
authors: C
authors: Mihalea
authors: From the Department of Interventional Neuroradiology (J.C., C.M., H.N., L.I., N.B., J.M., L.S.), Beaujon Medical Centre, Clichy, France.
authors: H
authors: H
authors: Neki
authors: Interventional X-Ray Innovation (D.R.), Philips Healthcare, Best, the Netherlands.
authors: D
authors: D
authors: Ruijters
authors: From the Department of Interventional Neuroradiology (J.C., C.M., H.N., L.I., N.B., J.M., L.S.), Beaujon Medical Centre, Clichy, France.
authors: L
authors: L
authors: Ikka
authors: From the Department of Interventional Neuroradiology (J.C., C.M., H.N., L.I., N.B., J.M., L.S.), Beaujon Medical Centre, Clichy, France.
authors: N
authors: N
authors: Benachour
authors: From the Department of Interventional Neuroradiology (J.C., C.M., H.N., L.I., N.B., J.M., L.S.), Beaujon Medical Centre, Clichy, France.
authors: J
authors: J
authors: Moret
authors: From the Department of Interventional Neuroradiology (J.C., C.M., H.N., L.I., N.B., J.M., L.S.), Beaujon Medical Centre, Clichy, France.
authors: L
authors: L
authors: Spelle
mesh_terms: D000328:Adult; D002533:Cerebral Angiography / Q000295:instrumentation*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement / Q000295:instrumentation; D015641:Radiography, Interventional / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015607:Stents; D014057:Tomography, X-Ray Computed / Q000295:instrumentation*; D016896:Treatment Outcome; D014963:X-Ray Intensifying Screens