Stroke is a serious complication of percutaneous coronary intervention and atrial fibrillation ablation procedures and patients have a high likelihood of persistent neurological deficits. Although formal criteria speak against intravenous or intra-arterial thrombolysis due to pre-existing antithrombotic and anticoagulation therapy, the conditions for recanalizing therapy are optimal due to the occurrence of vessel occlusion in the catheter suite or the chest pain unit. Brain imaging and an interdisciplinary approach are mandatory. In cases of intracerebral vessel occlusion intra-arterial thrombolysis possibly in combination with mechanical clot fragmentation is the first choice therapy. The management of the patient is always an individual therapeutic decision based on stroke severity, the pretreatment with antithrombotic and anticoagulation drugs, the availability of a neuro-interventionalist and the qualification of the local team.