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Introduction Endovascular therapy is the standard of care for acute ischemic stroke with large vessel occlusion. Balloon Guide Catheters (BGCs) aid in flow arrest, improving recanalization rates and reducing distal embolization. However, their cost, limited availability, and compatibility issues with aspiration catheters often pose practical challenges. We present a novel technique— Flow Arrest using Sonographic Transducer (FAST)—that replicates BGC function using external carotid compression under ultrasound guidance.Abstract C98 Figure 1Case Description A sexagenarian with atrial fibrillation and recent pacemaker implantation presented with dense right hemiplegia and aphasia (NIHSS >20) within 3 hours of symptom onset. Imaging revealed a left tandem occlusion involving the cervical ICA and distal MCA (ASPECTS 10, hyperdense MCA sign). Given an elevated INR of 1.96, intravenous thrombolysis was withheld, and mechanical thrombectomy was planned.An aspiration catheter restored carotid patency but failed to cross into the MCA. A stent retriever was deployed through a microcatheter. Before retrieval, aspiration tubing was connected to the guide sheath, and the FAST technique was employed—ultrasound-guided compression of the left common carotid artery. This provided flow arrest, facilitating first-pass TICI 3 recanalization. Follow-up imaging confirmed infarcts in the left basal ganglia and insula. At 2-month follow-up, the patient had a modified Rankin Score of 2 with persistent motor aphasia.Abstract C98 Figure 2Conclusions The FAST technique is a simple, cost-effective, and widely accessible alternative to BGCs. It enables proximal flow arrest during thrombectomy, facilitating efficient device transitions and improving recanalization outcomes—especially valuable in resource-limited settings.Abstract C98 Figure 3Conflict of Interest No