Background Ischemic stroke is the second most frequent cause of death globally. Mechanical thrombectomy (MT) has several advantages over thrombolytic drugs; it increases the therapeutic window beyond the 4.5-hour guideline for thrombolytics. A novel approach of pure thrombus aspiration emerged as a talented substitute for stent retriever thrombectomy (SRT). Forced Arterial Suction Thrombectomy (FAST) with a distal access catheter is simple, fast, and straightforward. This study aimed to compare between the mechanical suction in comparison to aspiration devices using distal axis catheter according to procedural safety, incidence of procedural complications, duration of thrombectomy and number of trials. Methods This randomized clinical trial included patients with emergent large vessel occlusions (ELVO) of distal carotid system. They were divided into two groups, group 1 included 20 patients treated by proximal aspiration and group 2 included 20 patients treated by stent retriever (SR) device (SRD). This study evaluated the outcomes by measuring the mean score of NHISS, modified Rankin scale (MRS) and non-contrast CT brain 24 hours after the procedures. Results There was no statistically significant difference between the studied groups regarding National Institutes of Health Stroke Scale (NIHSS) 0 hour and at 24 hours, as regard TICI initial, TICI First pass and TICI final, as regard ASPECT score at 0 & 24 hours, as regard MRS, as regard Systolic and diastolic blood pressure at recanalization, as regard incidence of complications and as regard grade for collaterals grading. Conclusion The incidence of successful reperfusion of the target vessel following both techniques was equally effective in achieving good clinical outcomes.