Objective: The role of the basilar artery morphological abnormalities (BAMA) in the pathogenesis of posterior circulation infarction (PCI) was summarized and analyzed based on the main line of the diagnosis and treatment of the basilar artery excessive bending combined with thrombus formation. The experience and lessons in this process was summarized which could provide reference and warning for further clinical diagnosis and treatment. Methods: This paper described a rare case of DWI-negative PCI 3 hours after onset in a young man as well as its whole process of diagnosis and treatment and the literature of the BAMA was reviewed and summarized. Results: This patient was diagnosed as basilar artery excessive bending combined with thrombosis by CTA, but eventually died of brain stem failure despite receiving intravenous thrombolytic therapy. Conclusion: BAMA should be fully taken into account in the pathogenesis of PCI. The clinical significance of vascular evaluation in patients with PCI and isolated vertigo should be paid enough attention to and the understanding of the clinical significance of the results of this assessment should be broadened in the clinical practice. ; 目的 以基底动脉过度弯曲并血栓形成病例的诊断治疗为主线，总结和分析了基底动脉形态异常在后循环梗死发病机制中的作用。总结病例的诊治经验训，为以后的临床诊疗提供一定的借鉴价值和警示意义。方法 本文描述了1例罕见的发病后3h DWI仍未显示病灶的后循环梗死的年轻患者诊断和治疗的全过程，并对基底动脉形态异常的相关文献进行回顾分析和总结。结果 本例患者通过头CTA确诊为基底动脉过度弯曲并血栓形成，虽经静脉溶栓治疗，但最终死于脑干功能衰竭。结论 后循环缺血的发病机制应该将基底动脉形态异常这一因素充分考虑在内。在临床上，对于后循环缺血及孤立性眩晕患者血管评估的临床意义应该给予足够的关注并拓宽对这一评估结果临床意义的认识。