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Direct aspiration through a balloon guide catheter can augment vessel wall injury

We report a 75‐year‐old woman with extracranial internal carotid artery occlusion treated with neurointervention. The patient presented with tandem lesions for which mechanical thrombectomy was performed. Retrieval of massive white clots and endothelial tissue by forceful manual aspiration via a balloon guiding catheter after angioplasty can be indicative of augmentation of vessel wall injury.