title: Remnants and recurrences after the use of the WEB intrasaccular device in large-neck bifurcation aneurysms.
abstract: BACKGROUND
  Flow disruption with the WEB technique has been developed to treat large-neck bifurcation aneurysms.
  
  
  OBJECTIVE
  To report our anatomic angiographic results at first (3-6 months) and second (18 ± 3 months) angiographic follow-up in a series of 15 patients.
  
  
  METHODS
  Fifteen patients (15 aneurysms) were consecutively treated in our center by 2 operators for a large-neck bifurcation aneurysm between March 2012 and February 2014. Results were evaluated by assessing WEB cage position at the aneurysm neck on angiography and high-resolution contrast-enhanced flat-panel detector computed tomography, contrast medium stagnation within the WEB and aneurysm on intraprocedural angiography, and 1-day time-of-flight magnetic resonance angiography. All aneurysms were followed up by angiography. Results at follow-up were graded as complete occlusion, neck remnant, or residual aneurysm. The 2 operators compared postprocedural and follow-up images and classified them as better, same, or worse. Subtracted images were compared in different projections to assess any WEB device compression or shape changes.
  
  
  RESULTS
  A worsening was observed between the postprocedural and first follow-up angiography in 10 of 14 (71.5%) and in 4 of 7 (57.2%) between the first and second control angiography. Compression of the WEB cage was observed at first follow-up in 8 of 14 (57.2%) and in an additional 3 of 7 cases (42.8%) at second control. Last angiography showed complete occlusion in 1 of 14 (7.2%), neck remnant in 8 of 14 (57.2%), and residual aneurysm in 5 of 14 (35.7%) cases.
  
  
  CONCLUSIONS
  This article draws attention to the risk of WEB compression and aneurysm recanalization. Future prospective studies should evaluate delayed WEB shape changes with different types of WEB devices (dual layer, single layer, single layer spherical).
  
  
  BACKGROUND
  CO, complete occlusionNR, neck remnantRA, residual aneurysm.
authors.affiliation: Department of Neuroradiology, University Hospital of Toulouse, Toulouse, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Cognard
authors.forename: Anne Christine
authors.initials: AC
authors.lastname: Januel
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome