The treatment window of endovascular thrombectomy (EVT) had been extended from 6 to 24 hours after stroke onset based on the positive results of recent trials. Delayed EVT beyond 24 hours after stroke onset is theoretically possible, only if there is small ischemic core, large mismatch volume and good collateral circulation. In carefully selected patients, delayed EVT is a considerable option when medical treatment fails or when the neurological status fluctuates. Here we presented a 61-year-old man with acute consciousness disturbance and left-sided weakness. Initial examination revealed suspicious chronic total occlusion of right distal internal carotid artery, thus the patient received medical treatment. However, due to fluctuating neurological status, EVT was performed after evaluation by perfusion image on post-stroke day 5. The right distal ICA was recanalized by stent retriever and balloon angioplasty. However, there were newly found acute infarction at right brainstem and cerebellum after EVT, and a thromboembolism via a right persistent trigeminal artery variant was the suspicious cause. Fortunately, a favorable outcome was achieved by the effort of a multidisciplinary stroke caring team.