Basilar artery occlusion (BAO) is a rare cause of paediatric stroke that may result in severe neurological disability including a ‘locked-in’ state. Acute interventional therapy for paediatric BAO is limited to a small number of published case reports. Of 13 previously published cases that have undergone acute intravascular therapy, six made a full neurological recovery, six had residual deficits ranging from mild dysarthria and ataxia to vegetative state and one patient died. The time from symptom onset to intervention was ≥12 h in 77% (10/13). We reported a 14-year-old female patient presenting with altered sensorium that progressed to a ‘locked-in’ state due to idiopathic BAO who made a full clinical recovery after successful mechanical thrombectomy at 24 h following symptom onset. Acute neuro-interventional therapy for paediatric BAO can result in complete neurological recovery despite the presence of severe neurological deficits and a prolonged period of time from symptom onset to clinical diagnosis.