This patient was transferred to ICU from a rural hospital with a left sided ischemic stroke. Endovascular clot retrieval was not feasible due to inability to facilitate interhospital transfer within necessary timeframe. Decision made to thrombolyse with tenecteplase. 

The hyperdensity of the involved vessels is due to the thrombus having previously formed and contracted, either within the heart or carotid bulb, prior to embolizing and occluding the left ICA.