Ischemic stroke is the fourth leading cause of disability and mortality in the United States. The overall risk of emboli detachment from a chronically occluded internal carotid artery (COICA) is around 7% per year. Despite receiving the best available medical therapy, about 6% to 24% of these patients will subsequently suffer transient or permanent ischemic complications annually. This has been theoretically attributed to a cerebrovascular hemodynamic impairment.