A 63-year-old African American male with a history of hypertension and coronary artery disease, presented as a stroke alert with sudden onset aphasia and right upper extremity weakness (NIHSS was 11). The time of the onset of his symptoms was unknown, he was not a candidate for IV thrombolysis. He was diagnosed with COVID-19 two weeks prior to his presentation, requiring a 4-day hospitalization with a peak D-dimer of 0.91 mg/L (reference range <0.5mg/L). Inpatient treatment included hydroxychloroquine, antibiotics, and thromboprophylaxis with daily subcutaneous Enoxaparin (40mg). Initial CT head showed ischemic strokes throughout left hemisphere. CT angiogram (CTA) of the head and neck revealed an extensive intraluminal thrombus in the left common carotid artery, extending distally into the petrous portion of the internal carotid artery (ICA). Conservative management with IV Unfractionated Heparin was initiated. Echocardiogram and telemetry monitoring ruled out cardio-embolic causes. The D-dimer was notably increased, 4.75µg/mL (reference range < 0.41µg/mL). Heparin infusion was transitioned to oral anticoagulation with Apixaban 5mg twice daily. The patient was seen 3 months after his stroke. His follow up NIHSS was 3, repeat CTA head and neck showed complete resolution of the ICA thrombus without any underlying significant carotid stenosis and D-dimer was normal, 0.36 µg/mL (reference range < 0.41µg/mL).