Plant, SamuelPatel, Biraj M.2020-12-042020-12-042020-10-24e11127http://hdl.handle.net/10919/101011This report describes a case of acute left middle cerebral artery ischemic stroke that occurred in a patient with unique anatomy of the vessels arising from the aortic arch that remained undiagnosed until the age of 36. The nature of the anatomical variance proved problematic in establishing access to the carotid artery via traditional transfemoral or transbrachial approaches, and direct access was established via left carotid puncture. The patient regained substantial neurologic function. The direct carotid approach described below serves as a viable alternate route to establishing reperfusion in patients with complex or problematic aortic arch anatomy.application/pdfenCreative Commons Attribution 4.0 Internationalischemic strokeinterventional neuroradiologymechanical embolectomydirect carotid artery punctureaortic archrare variantArticle - Refereedhttps://doi.org/10.7759/cureus.111271210332407202168-8184