Objective:To analyze the efficacy of local intra-arterial thrombolysis using urokinase in patients with acute ischemic vertebral basilar artery(VBA) stroke. Methods:Ninety-three patients were angiographically examined after VBA stroke. Forty-three patients were treated with local intra-arterial thrombolysis using urokinase,others were control group. The curative effect was compared and the relationship of revascularization 6 h before and after onset with the Glasgow outcome scale(GOS) scores three months later was analyzed. Results:Angiography showed occlusion of VBA in 93 patients. There was significant difference between the therapeutic group and control group(P < 0.01). In thrombolytic group, there were no significant difference between revascularization 6 h before and after onset in clinical prognosis(P > 0.05). Successful revascularization was achieved in 23 patients. Four patients had revascularization and good prognosis with GOS three months later in 6 patients who thrombolysised within 6 h,Sixteen patients had good prognosis with GOS three months later in 19 patients who had successful revascularization among 37 patients who thrombolysised after 6 h. Twelve patients died. Hemorrhage occurred in one patient. Reperfusion injury occurred in 19 patients, and arterial reocclusion occurred in one patient. There was a significant relationship between arterial recanalization rate and clinic prognosis(P < 0.01,r = 0.99). There was low ratio of successful recanalization in VBA with poor clinic prognosis in patients who thrombolysised after 6h. Conclusion:Successful recanalization of VBA occlusive could improve intra-arterial thrombolysis,which is an effective therapy for acute ischemic VBA infarction.There was significant relationship between arterial recanalization rate and clinic prognosis.