A 57-year-old man presented with symptoms of right middle cerebral artery (MCA) stroke (NIH Stroke Scale score [NIHSS] 19) including eyes and head deviation, proportional left hemiplegia, left hemianopsia, and left hemispatial neglect. MRI showed occlusion of the first segment of the right MCA (figure). Thrombolysis was initiated 3.5 hours after onset. First angiographic acquisition 1.5 hours later showed persistent occlusion. Successful recanalization was obtained by aspiration thrombectomy 6 hours after onset.