Balloon guide catheters: use, reject, or randomize?

Thrombectomy devices played an important role in the success of endovascular treatment trials over past five years. A balloon guide catheter (BGC) is adjunctive device used to arrest and reverse flow by inflating at its tip, which allows for reversal intracranial arteries during retrieval thrombectomy applying concomitant aspiration through lumen. Thereby, it can decrease risk clot fragmentation distal embolization. Despite numerous benchtop clinical observational studies showing superiority BGC conventional catheters improving reperfusion quality outcome, use still low practice. The reasons behind this reluctance might be related technical cost issues. Therefore, high level evidence data, i.e., a randomized trial, are needed increase implementation procedures. Nonetheless, several obstacles challenges prevent completion such efforts overcome them. We provide overview current opinions about BGCs neurointerventional community discuss feasibility possible trial answer question “should routinely acute ischemic stroke?”