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Internal carotid artery (ICA) occlusion typically affects the anterior circulation. However, in rare cases, it may present exclusively as posterior circulation ischaemia, particularly in the presence of anatomical variants such as a persistent trigeminal artery (PTA), an abnormal embryonic connection between the ICA and the basilar artery (BA).We report the case of a patient with ICA and PTA occlusion who presented clinically with a posterior circulation stroke. The initial National Institutes of Health Stroke Scale score was 20. CT angiography revealed occlusion of the ICA and distal BA. Following ICA angioplasty, a thrombosed PTA was identified. A combined thrombectomy technique (aspiration and stent retriever) was performed, achieving effective recanalisation of the PTA and posterior circulation, with a favourable clinical outcome.