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Introduction Remote aspiration (RAT) from a balloon guide catheter (BGC) positioned in the extracranial internal carotid artery (ICA) has been proposed as a rapid and minimally invasive approach for treating ICA terminus occlusions. By leveraging the ‘vacuum phenomenon’ to remove thrombi without directly contacting them, this technique may reduce procedural time and improve clinical outcomes.Aim of Study This pilot study reports the technical feasibility, efficacy, and safety of remote aspiration from a BGC for ICA terminus occlusions.Method We retrospectively reviewed 12 consecutive patients treated from January to December 2024. All underwent remote aspiration from a BGC (RAT) as the first pass. If RAT failed ( <mTICI 2b), standard mechanical thrombectomy was performed. Primary outcomes included immediate successful revascularization (mTICI ≥2b) and procedural time (groin puncture to reperfusion). Secondary outcomes were neurological improvement (NIHSS) at discharge, functional outcome (mRS) at three months, and procedure-related complications.Results Remote aspiration achieved immediate successful revascularization in 8 of 12 patients (66.7%). Overall final successful revascularization (including subsequent therapies after RAT failure) was 10 of 12 (83.3%). In successful RAT cases, the median groin-to-reperfusion time was significantly shorter (7:30 vs. 63.30 minutes, p=0.009). No symptomatic hemorrhages were observed. The median NIHSS at discharge was 5. Two patients died, and five were lost to follow-up. Among survivors, the median three-month mRS was 0.Conclusion RAT from a BGC appears feasible and time-efficient for ICA terminus occlusions. Larger studies are warranted to confirm these preliminary findings and to refine patient selection criteria.Conflict of Interest No