The objective of this paper was to analyse the technical and clinical outcome in patients receiving endovascular treatment for posterior circulation intracranial aneurysms at Royal Perth Hospital. The case notes and angiograms of 35 patients with ruptured and unruptured posterior circulation aneurysms treated by endovascular coil occlusion between 1992 and 1998 were included in the study. The degree of angiographic occlusion achieved, and periprocedural, short and long-term clinical outcome were retrospectively analysed. Total aneurysm occlusion was achieved at initial treatment in 46% of cases, with 90% or greater occlusion achieved in 97% of cases. For aneurysms 12 mm or less in diameter, 100% of patients treated electively, and 100% of patients with grade I or II subarachnoid haemorrhage treated in the acute postictal phase had a good clinical outcome (Rankin Disability Score 1 and 2), with no serious morbidity or associated mortality. Excluding patients with grade V subarachnoid haemorrhage, the treatment-related serious morbidity rate was 3.4% and procedure-related mortality rate was 0%. We conclude that endovascular management provides an effective means of treatment for selected cases of posterior circulation aneurysms.