Abstract The basilar artery and two vertebral arteries comprise the vertebrobasilar system and supply the posterior part of the circle of Willis and the posterior cerebral arteries. Vertebrobasilar disease accounts for approximately 20 per cent of ischaemic stroke. Occlusion of the basilar artery is an uncommon cause of stroke, but carries a poor prognosis with mortality rates up to 90 per cent. Patients who do survive rarely regain functional independence and are at risk of recurrent strokes. Patients with basilar artery occlusion can present with reduced level of consciousness, the locked-in state, hemi- or tetraplegia, cortical blindness, and cranial nerve palsies causing horizontal gaze palsy, facial palsy, and oropharyngeal palsy. Interventional techniques, including intravenous and intra-arterial thrombolysis, mechanical clot retrieval, and stent insertion, are available for basilar artery thrombosis. However, none of these approaches have been evaluated in terms of randomized controlled trials.