Balloon guide catheters for endovascular thrombectomy: a systematic review and meta-analysis of randomized controlled trials

Whether temporary blood flow arrest using balloon guide catheters (BGC) facilitates endovascular thrombectomy for acute ischemic stroke due to large-vessel occlusion (AIS-LVO) remains controversial. We conducted a meta-analysis of randomized controlled trials to evaluate the efficacy and safety of BGC utilization during thrombectomy for AIS-LVO. PubMed, Embase, Cochrane Library, Elsevier, and Web of Science databases were searched from inception to 1 June 2025, for studies evaluating BGC in AIS-LVO patients undergoing thrombectomy. Eligibility screening and data extraction were independently conducted by two investigators following PRISMA guidelines. The primary outcome was 90-day functional independence, defined as a modified Rankin scale (mRS) score of 0–2. Of 431 articles identified, two randomized trials involving 460 patients met the inclusion criteria, in which 230 patients received thrombectomy with blood flow arrest using BGC, and 230 patients without flow arrest. Compared with the nonflow arrest group, the flow arrest group showed no significant difference in 90-day functional independence (34.78% vs. 37.83%; odds ratio[OR], 0.88 [95% confidence interval [CI], 0.6–1.28]; <i>p</i> = 0.50), rates of eTICI 2c-3 at the end of the procedure (77.39% vs. 78.26%; OR, 0.95 [95% CI, 0.61–1.48]; <i>p</i> = 0.83), or emboli to new territory (3.04% vs. 6.09%; OR, 0.4 [95% CI, 0.04–3.58]; <i>p</i> = 0.41). Safety outcomes did not differ significantly between groups. Temporary blood flow arrest with BGC did not significantly improve the functional independence in patients receiving thrombectomy for AIS-LVO. This technique remains a subject for future studies to confirm its efficacy.