Introduction Proximal flow control and forced aspiration may improve the outcome of endovascular revascularization therapy with acute stroke. However, the actual clinical impact of combined use of balloon guiding catheter (BGC) and aspiration catheter is not well-known.

Aim of Study To evaluate the effectiveness of (BGC) use during aspiration thrombectomy in acute ischemic stroke with anterior large vessel occlusion (LVO).

Methods We retrospectively reviewed patients with acute ischemic stroke who underwent aspiration thrombectomy as a first line method for anterior LVO between 2017 and 2022. Patients were categorized based on the BGC use during the thrombectomy as BGC (+) or (−) groups. We performed 1:1 propensity score matching to establish a proper control group among the BGC (+) group. We analyzed and compared baseline characteristics, angiographic and clinical outcomes between the two groups.

Results A total of 155 patients (46 and 109 patients in the BGC (-) and BGC (+) groups, respectively) were included in the analysis. The complete recanalization rate, first pass effect (FPE), and 3 month good functional outcome rate were significantly higher in the BGC (+) group than in the BGC (-) group even after propensity score matching. Multivariate logistic regression analysis also revealed strong association between BGC (+) and 3 month good functional outcome (adjusted odds ratio (aOR), 5.099; 95% confidence interval (CI), 1.741–14.928; p=0.003), and FPE (aOR 7.407; 95% CI, 2.928–18.740; p<.0001).

Conclusion Combined use of BGC and aspiration catheter during thrombectomy may be effective in patients with anterior LVO.

Disclosure of Interest nothing to disclose