Mechanical thrombectomy (MT) is currently the golden standard treatment of large vessel occlusions, especially in anterior circulation acute ischemic stroke (AIS). At the same time, the problem of tandem occlusions (TO) seems especially important, since most of the major clinical MT studies did not specifically evaluate patients with concomitant extracranial occlusions or critical stenoses. To date, there is no universally accepted optimal treatment strategy for such tandem lesions in AIS: it remains unclear which lesion - intracranial or extracranial, should be treated first. The choice reperfusion method should be based on the patients' individual characteristics, data from non-invasive radiologic studies and the stroke team experience. This article presents a case of successful reperfusion therapy of acute TO of the internal carotid artery followed by contralateral carotid stenting in a patient with extracranial stenosing atherosclerosis.