A 65-years-old man was admitted to our hospital because of sudden-onset unconsciousness and left hemiparesis. On arrival, he showed consciousness disturbance, left hemiparesis, and left hemispatial neglect. These symptoms resulted in National Institutes of Health (NIH) stroke scale score of 17. Brain diffusion weighted MR imaging showed hyper-intense lesions at the right insula, putamen, and cortex of right frontal lobe. MR angiography revealed occlusions of the right internal carotid artery (ICA) and middle cerebral artery (MCA). Thrombolytic therapy with intravenous recombinant tissue plasminogen activator (IV-rtPA) was started 135 min. after onset, and cerebral angiography was performed immediately after IV-rtPA. Angiography of the right common carotid artery (CCA) showed that the ICA was nealy occluded. Thus, we performed percutaneous transluminal angioplasty (PTA) to the lesion. Then, we performed angiography of the ICA, it revealed MCA occlusion in the M1 proximal portion, so thrombectomy was performed. MCA was recanalized completely as Thrombolysis in Cerebral Infarction (TICI) Grade 3. Subsequently, we performed carotid artery stenting (CAS), and all procedure was finished uneventfully. On postoperative DWI, new lesions were not observed. Clinically, neurological status was gradually improved, and his discharge modified Rankin Scale (mRS) was 2 on the 36th hospital day.