Response to letter to editor regarding 'Anatomical characterization of the inferior petrosal sinus and adjacent cerebellopontine angle cistern for development of an endovascular transdural cerebrospinal fluid shunt'

We thank the authors for their interest in our study1 and would like to address the points that they raise in their letter to the editor.2 Based on preclinical and clinical testing of the endovascular shunt implant, we have determined that antiplatelet drugs are not required before the deployment of the device in the inferior petrosal sinus (IPS). As in other neurointerventional procedures, navigation of a modern low-profile catheter can be readily performed while on intravenous anticoagulation with reversal at the time of dural puncture. The described endovascular shunting device bears a proprietary heparin-based coating and is not intended to occlude or thrombose the IPS itself. Rather, the IPS is utilized as the path towards the cistern. Once connection between the IPS and the cerebellopontine angle (CPA) cistern is established, the device allows flow of cerebrospinal fluid (CSF) via a low-profile tubular valved shunt directly to the internal jugular vein, without needing to rely on IPS patency. Piercing of the dura overlying the IPS is …