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Introduction Carotid artery tortuosity is a challange in the endovascular treatment of ischemic stroke patients, leading to technical failure in mechanical thrombectomy and potentialy worse outcome.Distal balloon guide catheters may overcome this obstaclesAbstract C74 Figure 1Case Description An 83 y old woman suffered an acute ischemic stroke caused by an occlusion of the proximal M1 segment of the right middle cerebral artery.High ASPECT score and a favourable CT perfusion made her a good candidate for mechanical thrombectomy.However CT angiography demonstrated a type 3 aortic arch, a very tortuous common carotid artery and a looping (coiling) in the cervical segment of the right internal carotid artery.Through an 8 F long sheath in the brachiocephalic trunc, a 6 F distal balloon guide catheter (iNedit, iVascular) easily passed the carotid artery tortuosity (CAT) and looping in the internal carotid artery upon the cavernosal part of the carotid arterySuccesfull mechanical thrombectomy with stentretriever under distal ballon occlusion was performed.Final angiographic result TICI 3 in one pass.Abstract C74 Figure 2Conclusions Mechanical thrombectomy has become a widely used treatment option for acute intracranial large or medium vessel occlusion, using large-bore balloon guiding or aspiration catheters.However tortuous anatomy of the cervical arteries, in general the common and internal carotid artery may prevent advancing this large catheter towards the side of the occlusion and therefore impact the outcome of the patient.The iNedit distal balloon guide catheter (iVascular) used in this patient overcomes the very tortuous anatomy and made the intracranial mechanical thrombectomy successful with good clinical outcome.Abstract C74 Figure 3Conflict of Interest No