A 61-year-old man with basilar artery thrombotic occlusion was successfully treated by a combination of local infusion of tissue plasminogen activator (t-PA) followed by percutaneous transluminal angioplasty (PTA). t-PA superselective infusion combined with the mechanical destruction of the clot by the guide wire was effective for recanalization. A Stealth dilation catheter, with a 2.5-mm balloon diameter and 10-mm length, was used for PTA. A balloon inflation time of 60 seconds with 4 atmospheres of pressure was delivered for successful dilation of the basilar artery. It was confirmed to be widely patent on follow-up angiography 40 days after the combined procedure with no further ischemic attacks apparent on clinical examination at 6 months.