This case report demonstrates that mechanical clot disruption and retrieval may be performed safely and successfully in a child with basilar artery (BA) thrombosis. A 16-year-old boy presented to our institution with locked-in syndrome 20 h after symptom onset. Brain MRI and cerebral angiography findings were consistent with BA occlusion. The child underwent endovascular therapy with clot retrieval followed by balloon angioplasty achieving immediate recanalization and clinical recovery on 3-month follow-up. This case highlights the use of primary neurointerventional devices in children with BA occlusion presenting beyond the conventional therapeutic window for other interventions.