Acutely ruptured atherosclerotic plaques with adjacent floating clot within the internal carotid artery in patients suffering from extra-/intracranial tandem lesions are often treated with stent-assisted balloon angioplasty. We present a strategy to retrieve the extracranial thrombus using the “stent retriever assisted vacuum-locked extraction” (SAVE) method, which initially was described for the intracranial vasculature. The extracranial SAVE (eSAVE) method could be an additional tool for the treatment of acute tandem lesions.