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Balloon guide catheters (BGCs) are designed to induce flow arrest during mechanical thrombectomy procedures for acute ischemic stroke due to large-vessel occlusion and have been associated with improved clinical and angiographic outcomes. We conducted a systematic review and meta-analysis evaluating the relative technical and clinical outcomes associated with BGC versus non-BGC approaches. A systematic review of clinical literature using the PubMed database was undertaken to identify multiarm studies published between 2010 and 2021 reporting the use of BGC versus non-BGC approaches for stroke treatment. Data collected included complete recanalization (thrombolysis in cerebral infarction, TICI), first-pass effect TICI 3, puncture-to recanalization time, number of endovascular attempts, distal embolization, symptomatic intracerebral hemorrhage, 90-day modified Rankin Scale score 0–2, and 90-day mortality. Subgroup analyses assessed the impact of treatment device (stent-retrievers, contact aspiration, combination therapy, and not specified/other). A random effects model was fit for each outcome measure. Fifteen studies were included. Compared with non-BGC approaches, patients treated with BGCs had greater odds of TICI 3 (odds ratio [OR] 1.57; 95% confidence interval [95% CI] 1.08–2.29) and first-pass effect TICI 3 (OR 3.63; 95% CI 2.34–5.62), reduced puncture-to-revascularization time (mean difference –7.8; 95% CI –13.3 to –2.2), fewer endovascular attempts (mean difference –0.47; 95% CI –0.68 to –0.26), reduced odds of distal emboli (OR 0.34; 95% CI 0.17–0.71) and symptomatic intracerebral hemorrhage (OR 0.66; 95% CI 0.51–0.86), greater odds of 90-day modified Rankin Scale score 0–2 (OR 1.51; 95% CI 1.27–1.79), and reduced odds of mortality (OR 0.69; 95% CI 0.57–0.82). BGCs yield superior technical and clinical outcomes while reducing patient complications. [ABSTRACT FROM AUTHOR]