75 year old right-handed woman with new-onset atrial fibrillation developed sudden right hemiplegia, neglect, and global aphasia during evaluation for cardioversion in the hospital facility. A and B, non-enhanced CT brain scan demonstrates asymmetric density in the left carotid terminus (arrow) but no evidence of stroke or hemorrhage. Because of the likelihood of a carotid “T” occlusion and low likelihood of flow restoration at this location with intravenous thrombolytic therapy, the patient was immediately referred for intra-arterial treatment. C, Left carotid arteriography shows opacification of the left external carotid artery branches but intracranial occlusion of the left internal carotid artery (arrow). D, a mechanical thrombectomy device, in this case the Concentric Merci X-series device and one of a number of stroke now undergoing clinical testing, was deployed through a microcatheter using standard transfemoral catheterization technique across the site of the occlusion in the left carotid terminus and proximal left middle cerebral artery (arrow). E, left carotid arteriography immediately following thrombectomy demonstrates complete restoration of flow in the left anterior circulation (arrow) without the use of thrombolytic agents and the attendant risks of intracranial hemorrhage. F, CT brain scan following treatment demonstrates to reperfusion hemorrhage and the patient made an excellent neurological recovery. At 30-day followup, she was able to sign the research consent for her original thrombectomy procedure.