We present the case of a middle-aged patient who had four recurrent acute basilar artery occlusions over a period of 3 months, each time successfully treated with mechanical thrombectomy. Extensive stroke work-up showed no obvious stroke etiology aside from a dysplastic right vertebral artery with multifocal stenoses. Treatment with different antiplatelet and anticoagulant regimes did not prevent basilar artery occlusion recurrence. Therefore, transarterial coil occlusion of the V4-segment of the right vertebral artery was performed as ultima ratio without complications. At final discharge, the patient had no persistent neurological deficits. No further cerebrovascular events occurred over a 12-month follow-up period.