A 58-year-old patient presented with a severe neurological deficit due to a stroke caused by an occlusion of the left internal carotid artery siphon. Standard treatment failed and neurosurgical consult was delayed. Because of a favorable perfusion imaging finding, microsurgical revascularization via an extra-intracranial bypass (left superficial temporal artery - left middle cerebral artery) was performed 36 hours after the onset of the symptoms. The outcome of the patient was favorable. The authors want to emphasize the need to actively seek patients with a severe neurological deficit and still viable brain tissue. The time window and treatment alternatives are discussed.

• Keywords
• 4D CT angiography, CT perfusion, Carotid artery dissection, Extra-intracranial bypass, Intracranial atherosclerosis, Large vessel occlusion,
• MeSH
• Carotid Artery, Internal surgery   MeSH
• Stroke * diagnostic imaging   etiology   surgery   MeSH
• Ischemic Stroke * complications   MeSH
• Middle Aged MeSH
• Humans MeSH
• Perfusion adverse effects   MeSH
• Cerebral Revascularization * methods   MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH
• Research Support, Non-U.S. Gov't MeSH