The basilar artery is the main arterial contributor to the posterior circulation. Interruptions of this flow can cause devastating strokes and neurological demise. While most patients with a basilar artery occlusion suffer from a high rate or morbidity and/or mortality, a small subset survive but have progressive symptomatic decline. Delayed revascularization of these patients with chronic basilar artery occlusions based on symptomatic progression may provide a favorable risk-benefit ratio, but requires appropriate patient selection.