Endovascular techniques for the treatment of intracranial aneurysms have rapidly evolved over the past 15 years since the introduction and subsequent US Food and Drug administration approval of the Gugleilmi detachable coil. During this period, a number of different coil designs and adjunctive devices have been developed to facilitate the treatment of more complex and challenging cerebral aneurysms. One such adjunctive device, the hypercompliant occlusion balloon, can be temporarily inflated during the delivery of embolization coils to prevent their prolapse into the parent vessel. This technique, known as balloon assisted treatment (BAT), remains somewhat controversial as many operators do not incorporate this approach into their practice, favoring stent supported techniques instead. Moreover, those operators who do practice BAT use a variety of different approaches. In this review, we discuss the theoretical concepts underlying BAT, the potential advantages and disadvantages of this approach and finally the technical evolution of BAT in our endovascular practice.