A demonstrative case of acute supraclinoid internal carotid artery (ICA) occlusion in a 63-year-old man presented with acute onset of right hemiparesis. Left supraclinoid ICA occlusion was evident on left internal carotid angiogram (Upper left). An intra-arterial urokinase infusion with mechanical clot disruption and balloon angioplasty was performed (Upper right). A final angiography shows a successful recanalization of the left distal ICA (Lower left). Computed tomographic angiography after 3 months shows a good arterial patency (Lower right).