The clinical burden of peripheral arterial events is substantial, with high case fatality, poor functional outcome, and a high rate of emergency and subsequent vascular intervention to prevent death and limb loss . We present a case of left upper extremity paresis secondary to acute brachial artery occlusion in a patient with active NSTEMI in the setting of paroxysmal atrial fibrillation. The patient was initially suspected to have a cerebrovascular attack (CVA); however, the CT head was negative for acute stroke. The presence of skin mottling, coolness of the arm, pallor, decreased sensation, and pulseless led to a further investigation with CTA of the upper extremity, confirming the diagnosis of acute left brachial artery occlusion.