A 65-year-old man improved significantly during intravenous thrombolysis with recombinant tissue plasminogen activator (tPA) for acute stroke due to thrombotic occlusion of the basilar artery apex. However, 5 minutes after the end of tPA infusion, he developed anterior circulation clinical symptoms. Angiography showed signs of left middle cerebral artery and anterior cerebral artery occlusion. Endovascular recanalization by mechanical thrombus aspiration, and intra-arterial infusion of tPA (20 mg) was followed by complete left middle cerebral artery recanalization. The patient showed an improvement of 11 points of the National Institutes of Health Stroke Scale score at hospital discharge and a 3-month modified Rankin scale score of 3. In patients with early recurrent ischemic stroke involving an initially unaffected vascular territory after intravenous thrombolysis, endovascular recanalization can be considered safe and effective.