Complete occlusion related to MCA dissection is difficult to diagnose with certainty due to pathognomonic features of the dissection that may not be revealed in angiography. A 45-year-old man with complete occlusion of left M1. Left : Left internal carotid angiogram showing complete obstruction of the left middle cerebral artery with focal intimal flap (arrow). Right : Left internal carotid angiogram after initial contrast aspiration thrombectomy using a Penumbra catheter showing a double lumen and intimal flap (arrows). The patient was discharged without neurological complications. The authors concluded that the first option for endovascular treatment with patients with MCA dissection and complete occlusion should be contact aspiration thrombectomy without passage of a microcatheter.