Concomitant recent myocardial infarction (MI) in patients presenting with acute ischaemic stroke (AIS) is considered a relative contraindication for thrombolysis. Mechanical thrombectomy is recognised as an alternative recanalisation therapy to avoid risk of haemorrrhagic complications. We report a 77-year-old patient who previously had recent admission for late presentation ST elevation myocardial infarction (STEMI) and currently presented with right-sided hemiplegia, dysphasia and reduced level of consciousness at 30 minutes from the onset. An urgent cerebral angiography showed total occlusion of the left middle cerebral artery (MCA). Successful mechanical thrombectomy was performed instead of administration of intravenous (IV) thrombolysis with excellent neurological recovery. This case report highlights the importance of patient transfer to a more comprehensive stroke center in the management strategies of the AIS.