A 71 year-old woman woke up with numbness and clumsiness of her right hand. Additionally, she complained of difficulty thinking and often felt like she would fall. On neurological examination she had full strength, but in comparative testing the right hand was weaker. Her past medical history was remarkable for arterial hypertension and coronary heart disease with coronary stenting undertaken 12 years ago. The patient was diagnosed with a proximal left internal carotid artery stenosis (CT angiogram). In addition, brain imaging showed subcortical and cortical ischemic changes and increased Tmax on head CT perfusion imaging (Figures 1) further supporting the diagnosis of a symptomatic carotid artery stenosis.