Abstract: Objective To investigate the safety and efficacy of endovascular therapy for moderate and severe patients with acute basilar artery occlusion(BAO). Methods The data of 28 coma patients with acute BAO treated by endovascular therapy was retrospectively analyzed. According to preoperative symptoms, 17 coma cases without tetraplegia were selected as moderate group and 11 coma cases with tetraplegia were selected as severe group. The baseline data, preoperative status, treatment methods, successful recanalization rate, occurrence of hemorrhage of brain parenchyma, and modified Rankin scale(mRS)grading after 3 month were recorded. Results Out of the 28 patients, 20(71.4%)presented as simple embolistic occlusion, and were treated by stent embolism removal, 8(28.6%)as intracranial atherosclerosis-related occlusions, among whom 2(7.1%)were recanalized after the passing of catheter, and the other 6(21.4%)were treated with balloon dilatation or stent implantation after stent thrombectomy. Twenty-six patients(92.9%)obtained successful revascularization, there was one case failed to get revascularization in moderate group and severe group, and both patients were dead. At the same time, there was one patient with parenchymal hemorrhage after operation in each group, and the two patients were dead. At 3-month followed-up, 6 patients(35.3%)presented as good prognosis in the moderate group(mRS classification ranging from 0 to 2 grading), and none with good prognosis occurred in the severe group.There were 3 deaths(17.6%)in moderate group and 6(54.5%)in severe group. Conclusion Endovascular therapy is safe and effective for coma patients without tetraplegia caused by acute BAO. But it can't improve the 3-month prognosis for coma patients with tetraplegia.