Fig 1.

This patient presented with severe right hemiplegia and aphasia (NIHSS score = 20). Initial MR imaging revealed a DWI-ASPECTS = 6 after 4.5 hours since symptom onset, associated with left tandem ICA and middle cerebral artery occlusions. The initial angiogram (A) demonstrates left internal carotid occlusion related to cervical dissection. We then carefully navigated the microcatheter through the dissected ICA to the intracranial occlusion (B). Thrombectomy performed after contralateral femoral puncture and right ICA run shows a functional circle of Willis and no residual left M1 occlusion (C). The posterior communicating artery is also permeable as seen on the left vertebral artery run (D). Consequently, we decided not to treat the cervical ICA dissection, and the artery was left in its initial condition (E).