Carotid artery revascularization using the Walrus balloon guide catheter: safety and feasibility from a US multicenter experience

Mohamed M. Salem, Svetlana Kvint, Ammad A. Baig, Andre Monteiro, Gustavo M. Cortez, Anna L. Kuhn, Oded Goren, Shamsher Dalal, Brian T. Jankowitz, Omar Choudhri, Daniel Raper, Omar Tanweer, Pascal Jabbour, Peter Kan, Robert M. Starke, Elad I. Levy, Christoph J. Griessenauer, Ajit S. Puri, Ricardo Hanel, Adnan H. SiddiquiJan Karl Burkhardt

Research output: Contribution to journalArticlepeer-review


Introduction The Walrus balloon guide catheter (BGC) is a new generation of BGC, designed to eliminate conventional limitations during mechanical thrombectomy. Objective To report a multi-institutional experience using this BGC for proximal flow control (PFC) in the setting of carotid artery angioplasty/stenting (CAS) in elective (eCAS) and tandem strokes (tCAS). Methods Prospectively maintained databases at 8 North American centers were queried to identify patients with cervical carotid disease undergoing eCAS/tCAS with a Walrus BGC. Results 110 patients (median age 68, 64.6% male), 80 (72.7%) undergoing eCAS and 30 (27.3%) tCAS procedures, were included (median cervical carotid stenosis 90%; 46 (41.8%) with contralateral stenosis). Using a proximal flow-arrest technique in 95 (87.2%) and flow-reversal in 14 (12.8%) procedures, the Walrus was navigated into the common carotid artery successfully in all cases despite challenging arch anatomy (31, 28.2%), with preferred femoral access (103, 93.6%) and in monitored anesthesia care (90, 81.8%). Angioplasty and distal embolic protection devices (EPDs) were used in 91 (83.7%) and 58 (52.7%) procedures, respectively. tCAS led to a modified Thrombolysis in Cerebral Infarction 2b/3 in all cases. Periprocedural ischemic stroke (up to 30 days postoperatively) rate was 0.9% (n=1) and remote complications occurred in 2 (1.8%) cases. Last follow-up modified Rankin Scale score of 0–2 was seen in 95.3% of eCAS cohort, with no differences in complications in the eCAS subgroup between PFC only versus PFC and distal EPD (median follow-up 4.1 months). Conclusion Walrus BGC for proximal flow control is safe and effective during eCAS and tCAS. Procedural success was achieved in all cases, with favorable safety and functional outcomes on short-term follow-up.

Original languageEnglish (US)
Pages (from-to)709-717
Number of pages9
JournalJournal of neurointerventional surgery
Issue number7
StatePublished - Jul 2022

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery


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