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

UMMS Affiliation

Department of Radiology

Publication Date


Document Type



Analytical, Diagnostic and Therapeutic Techniques and Equipment | Cardiovascular Diseases | Nervous System Diseases | Neurology | Neurosurgery | Radiology | Surgery


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.


atherosclerosis, balloon, cervical, stroke

DOI of Published Version



Salem MM, Kvint S, Baig AA, Monteiro A, Cortez GM, Kuhn AL, Goren O, Dalal S, Jankowitz BT, Choudhri O, Raper D, Tanweer O, Jabbour P, Kan P, Starke RM, Levy EI, Griessenauer CJ, Puri AS, Hanel R, Siddiqui AH, Burkhardt JK. Carotid artery revascularization using the Walrus balloon guide catheter: safety and feasibility from a US multicenter experience. J Neurointerv Surg. 2021 Oct 22:neurintsurg-2021-018126. doi: 10.1136/neurintsurg-2021-018126. Epub ahead of print. PMID: 34686574. Link to article on publisher's site

Journal/Book/Conference Title

Journal of neurointerventional surgery


Full author list omitted for brevity. For the full list of authors, see article.

Related Resources

Link to Article in PubMed

PubMed ID