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Correspondence on ‘Carotid artery revascularization using the Walrus balloon guide catheter: safety and feasibility from a US multicenter experience’
  1. Adnan H Siddiqui1,2,
  2. Mohamed M Salem3,
  3. Jan-Karl Burkhardt3
  1. 1 Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
  2. 2 Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
  3. 3 Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Jan-Karl Burkhardt, Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA 19104, USA; Jan.Burkhardt{at}

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We thank the authors1 for their interest in our work and the Journal Editor for the opportunity to respond to their comments. Most of the commentary from the authors is common knowledge. For instance, carotid artery stenting (CAS) and carotid endarterectomy (CEA) are equivalent based on CREST2 and now ACST-2.3 They also state matter-of-factly that flow reversal is only established if both external carotid artery (ECA) and internal carotid artery (ICA) are occluded. There is no doubt that a distal embolic protection device (EPD) is currently the standard of care for CAS and we are – as is everyone else – using an EPD whenever possible. …

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  • Contributors All authors contributed to the publication conception and design. The first draft was done by AHS, MMS, and J-KB. All authors contributed to the editing of prior versions, and read and approved the final version of the submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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