Fig. 4. Illustration of the key elements of the BADDASS approach. A balloon guide catheter is placed in the cervical internal carotid artery (A). A microwire and microcatheter, loaded with a stent retriever is then advanced past the thrombus in the inferior M2 division and the stent retriever is deployed distally (B). The microcatheter is then removed (C). Slight traction is applied to the stent wire (D) to facilitate navigation of the distal access catheter, which is advanced to the proximal clot interface (E,F). Immediately prior to clot retrieval, the balloon is inflated, aspiration is applied to the distal access catheter and the balloon guide catheter (“double aspiration” G). The distal access catheter, stent retriever, and the entrapped clot are then retrieved in the balloon guide catheter bore and removed out of the patient under maintained double aspiration (H). BADDASS: BAlloon guide with large bore Distal access catheter with Dual Aspiration with Stent-retriever as Standard Approach (Reprinted with permission from: Ospel JM, Holodinsky JK, Goyal M. Management of Acute Ischemic Stroke due to Large Vessel Occlusion: JACC Focus Seminar. J Am Coll Cardiol. 2020. In press. © American College of Cardiology Foundation).