OBJECTIVE Carotid artery occlusions traditionally have extremely poor outcomes with intravenous tissue plasminogen activator treatment or emergent thromboendarterectomy. We retrospectively reviewed our institutional experience with acute carotid occlusions using internal carotid artery endovascular thrombolysis and stent placement. METHODS We studied the radiographic and clinical characteristics of 17 patients with an acute cervical internal carotid artery occlusion treated with stent-assisted endovascular thrombolysis. Clinical outcomes were assessed by using National Institute of Health Stroke Scale (NIHSS) scores, which were obtained on admission and discharge. Inclusion criteria were an NIHSS score of at least 6 and the presence of significant penumbra on computed tomographic perfusion. Morbidity and mortality data were collected and analyzed. RESULTS Seventeen candidates met our inclusion criteria, 16 (94%) of whom had successful immediate recanalization of the internal carotid artery. On admission, the mean NIHSS score was 16.5 and the mean modified Rankin Scale score was 4.8. The mean NIHSS score improved to 6.9 on discharge, with a mean modified Rankin Scale score of 2.88. Eight (47%) patients recovered ambulatory function on discharge. The overall mortality rate of our series was 17%. CONCLUSIONS In the setting of acute ischemic stroke, emergent carotid artery thrombolysis and stenting is a promising treatment for acute carotid occlusions with excellent recanalization rates and favorable clinical outcomes.