COMMENTARY with these catheterizations. Left carotid artery (LCA) bifurcation was present at approximately C3 level. There was large amount of partially calcified atherosclerotic plaque present along the LCA bifurcation. The cervical LICA was occluded at its origin. Left common carotid artery and the left external carotid artery were patent without significant stenosis using the North American Symptomatic Carotid Endarterectomy Trial criteria. Cranial images reveal that there was minimal patchy

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... collateralized stagnant opacification of the intracranial (LICA) and subtle minimal opacification of the left middle cerebral artery. The cross flow through the anterior communicating artery supplied the left anterior cerebral artery. There was a congenitally small A1 segment left anterior cerebral artery. There were moderate leptomeningeal collaterals from the left anterior cerebral artery to the occluded left middle cerebral artery territory. The diagnostic catheter was advanced into the LICA over a stiff angled glidewire where it was exchanged over a Rosen wire for a 6 French, 90 cm sheath. A Zoom 71 reperfusion catheter was then advanced over the Fathom wire into the distal cervical LICA. The Zoom catheter was then used to perform aspiration thrombectomy. After a single pass the device yielded a just