Combination　therapy　plays　a　critical　role　in　optimizing　surgical　outcomes　for　patients　with　locally　advanced　hepatocellular　carcinoma　(HCC)　complicated　by　bile　duct　tumor　thrombus　(BDTT).　Current　neoadjuvant　strategies　integrate　local　and　systemic　modalities　to　reduce　tumor　burden　and　recurrence　rate.　However,　the　combination　of　transarterial　chemoembolization　(TACE),　lenvatinib,　and　PD-1　inhibitors　(triple　therapy)　as　a　neoadjuvant　regimen　for　HCC　with　BDTT　has　not　been　previously　reported.　Here,　we　present　the　case　of　a　61-year-old　man　with　HBV-associated　HCC　and　BDTT,　initially　deemed　high-risk　for　direct　resection　due　to　tumor　size　(7　cm)　and　biliary　involvement.　The　patient　underwent　one　session　of　TACE　followed　by　two　months　of　lenvatinib　(12　mg/day)　and　sintilimab　(200　mg　every　3　weeks).　Post-treatment　contrast-enhanced　MRI　revealed　complete　resolution　of　BDTT　and　partial　response　of　the　primary　tumor.　Subsequent　right　hemihepatectomy　confirmed　extensive　tumor　necrosis　(＞90%)　with　negative　margins.　At　15-month　follow-up,　surveillance　imaging　showed　no　recurrence.　The　patient　experienced　only　grade　1　hypertension,　managed　without　treatment　interruption.　This　case　highlights　the　potential　of　triple　therapy　as　a　neoadjuvant　approach　to　downstage　advanced　HCC　with　BDTT,　enabling　curative　resection　while　maintaining　a　manageable　safety　profile.　Further　studies　are　warranted　to　validate　its　efficacy　in　larger　cohorts　and　define　optimal　treatment　protocols.