Introduction/Purpose The use of a balloon‐guided catheters (BGC) during mechanical thrombectomy involves an inflatable balloon for proximal flow arrest, potentially reducing the risk of distal clot embolization and improving reperfusion outcomes. While previous studies have improved outcomes compared to non‐BGC procedures, recent clinical trials have shown variable results, including higher rates of unfavorable neurological outcomes. This meta‐analysis aims to address these inconsistencies in the literature to evaluate the benefits of BGC on radiographical and clinical outcomes. Materials and Methods A literature search was conducted across four databases from Jan 1, 2010 to May 31, 2025, to identify studies comparing the outcomes of patients undergoing mechanical thrombectomy with BGC and non‐BGC procedures.Primary outcomes included favorable neurological outcome (modified Rankin Scale mRS 0‐2 at 90 days), all‐cause mortality, successful reperfusion (final mTICI score 2b‐3 at the end of the procedure), first‐pass reperfusion, distal embolization, embolization to a new territory, and symptomatic intracranial hemorrhage (sICH). Subgroup analyses were performed by study type: non‐matched cohorts, propensity score‐matched (PSM) cohorts, and randomized clinical trials (RCTs). Results A total of 33 studies met our inclusion criteria, including 2 RCTs, 5 PSM cohorts, 23 non matched cohorts, and 3 post‐hoc RCT subanalyses. Our total sample included 10,301 patients, with 5616 undergoing BGC and 4685 undergoing non‐BGC thrombectomy. The BGC group showed a significantly higher rate of favorable neurological outcomes (RR=1.15,95%CI=1.05‐1.26,p=0.002), successful reperfusion (RR=1.08,95%CI=1.04‐1.12, p<0.0001), and first‐pass reperfusion (RR=1.34,95%CI=1.12‐1.61,p=0.002,I 2 =88%), while having significantly lower rates of all‐cause mortality (RR=0.83,95%CI=0.76‐0.90,p<0.00001) and distal embolization (RR=0.57,95%CI=0.42‐0.79,p=0.0008,I 2 =53%). These differences were primarily driven by retrospective cohort studies, with no significant differences found amongst RCTs and post‐hoc analyses. The PSM subgroup showed a significantly decreased mortality rate (RR=0.72, 95%CI=0.53‐0.98, p=0.04). There was no significant difference in rates of new‐territory embolization (p=0.19) or sICH (p=0.08). Conclusion Our meta‐analysis of over 10,000 patients showed that the use of BGC was associated with significantly improved angiographic, procedural, clinical outcomes, as well as lower rates of complications such as distal embolization and mortality. However, when stratifying by study type, we identified no benefit in patients derived from clinical trials, and only a mortality benefit across PSM studies. Although the limited benefit observed in high‐quality studies restricts the broad recommendation for BGC, our findings support its safety and underscore the need for additional multicenter clinical trials to further describe potential neurological benefits along with stratifying outcomes by the use of adjunct thrombectomy devices. image
Pichardo-Rojas et al. (Sat,) studied this question.