Acute vertebrobasilar artery occlusion is a life-threatening event, even after thrombolytic treatment with local intraarterial (IA) recombinant tissue plasminogen activator. We report a 70-year-old man with acute vertebral artery occlusion in which IA thrombolysis resulted in partial recanalisation and revealed pre-existing severe stenosis as the underlying cause. Stenosis was managed with stenting with excellent long-term clinical as well as angiographical outcomes.