Illustration of the Merci L5 thrombectomy device removing thrombus. The L5 device is a helix of fl exible nitinol wire with an arcade of fi laments secured to the loops of the helix. This differs from the X5 and X6 Merci Retrievers by having fi laments and no taper to the coils. Within 8 hours of acute ischemic stroke, the balloon guide catheter is placed via femoral artery into the proximal internal carotid or vertebral artery. The blue microcatheter is advanced through the balloon guide catheter and placed through the occlusion using a microguidewire. The guidewire is then exchanged for the Retriever, which is advanced distal to the clot and several loops are deployed (A). The device is further deployed so as to fully ensnare the clot (B). Then, the proximal balloon of the guide is infl ated to prevent distal embolization, some torquing maneuvers are applied, and the microcatheter and Retriever are withdrawn together to retrieve the clot (C).