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Introduction Posterior circulation strokes account for up to 20% of all ischemic strokes and may present diagnostic and therapeutic challenges, particularly in the context of tandem occlusions. We present a case of a 43-year-old male with vertebral artery occlusion and distal embolism to the posterior inferior cerebellar artery (PICA), successfully treated with mechanical thrombectomy.Abstract C91 Figure 1Case Description 43-year-old male was admitted emergently due to sudden-onset dysarthria, left-sided hemiparesis, ataxia, nausea, and bilateral temporal headache (NIHSS 12). CTA revealed complete occlusion of the left vertebral artery (LVA) and (PICA) (Fig.1). After excluding intracranial bleeding in the neCT intravenous thrombolysis was administered. Initial angiography (OTP 3h) revealed critical atherosclerotic stenosis of the LVA ostium and thrombus in the PICA with protrusion to the V4 segment of the LVA (Fig.2). Revascularization was achieved transradially in two stages: First, LVA angioplasty with balloon-mounted stent Omnilink Elite 5.0x12mm placement. Subsequently, bolus of Integrilin was administered and then continuous infusion was started. Next, mechanical thrombectomy from PICA with Solitaire X 3x20mm and Rist access catheter was perfromed – result mTICI 2C (OTR 4h) (Fig.3). Patient neurological status improved during hospitalization and was discharged after 10 days in good stable condition (NIHSS 3, mRS 2).Abstract C91 Figure 2Conclusions This case illustrates the importance of rapid diagnosis and intervention in posterior circulation tandem occlusion. Combined thrombolysis and endovascular therapy proved effective in restoring perfusion in the cerebellar artery occlusions. Early identification and multidisciplinary management are crucial in and improving functional outcomes and optimizing prognosis for patients with complex posterior circulation stroke.Abstract C91 Figure 3Conflict of Interest No