We are pleased that Foerch and colleagues have confirmed our observation that common carotid artery intima-media thickness (CCA-IMT) is significantly greater on the left than on the right side.1 With the large number of subjects they studied, this phenomenon of a greater left CCA-IMT now seems to be genuine. Although Foerch et al state that they do not completely agree with the interpretation of our findings, we think that there is no major disagreement. In fact, in our paper we acknowledged the limitation of having focused only on the common carotid artery, and we fully accept the possibility that the left-right difference may not be apparent throughout the carotid system as the data from the Carotid Atherosclerosis Progression Study show. We also agree that an increased CCA-IMT is not a lesion which in itself progresses to atherosclerosis or predisposes to thromboembolism. For this reason, we did not at all suggest that there would be a causal relationship between a higher CCA-IMT on the left side and the higher frequency of left-sided strokes. We only indicated that both phenomena could be related to a similar mechanism, ie, greater hemodynamic stress in the left carotid system. Actually, the increased IMT may be due to medial hypertrophy rather than intimal thickening, a possibility that we also discussed in our paper. Of course, we were also concerned that there may have been a bias in the overrepresentation of left-sided cortical infarcts. However, since initial stroke severity and final outcome in our Registry were similar between left and right hemispheric infarcts and since patients with minor symptoms are unlikely to be referred elsewhere, we think that such a bias is less likely. Nevertheless, we agree that this issue needs further investigation.