Four cases of basilar artery occlusion with a follow-up from 7 to 12 years are reported. The first patient, a 60 year old woman, had a proximal occlusion which was revealed by an acute brain stem ischemia. The second case was a 63 year old man with an aortic aneurysm who had a single episode of vertebro-basilar insufficiency. Cerebral angiography demonstrated a lower basilar artery occlusion. The third patient, a 60 year-old woman, had been operated from right carotid artery and left vertebral artery stenosis; 8 years later, without clinical manifestations, a left carotid artery stenosis and an occlusion of the lower part of the basilar artery were discovered. The evolution was eventless after a left carotid endarterectomy. The last case was a 60 year old man who had a lower basilar artery occlusion associated with a left internal carotid occlusion. There was a full recovery after a hemiplegic stroke. From our personal cases and the review of the literature, long term survival after basilar artery occlusion may occur in occlusions restricted to the lower or middle part of the basilar artery and with a good collateral supply from carotid and cerebellar arteries.