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Objectives: Our goal was to describe outcomes in a single‐center, real‐world series of patients with acute basilar artery occlusion in a middle‐income country. In addition, we assessed potential outcome predictors. Material and Methods: Data from 28 patients were retrospectively reviewed. The primary outcome was death until last follow‐up. Other outcomes were rates of favorable outcome until last follow‐up and rates of intracranial hemorrhage. Outcomes were compared in subgroups according to several variables, including reperfusion (REP group) or no reperfusion (NOREP group) interventions, with chi‐squared, Fisher's exact test, or Mann–Whitney tests. Results: The rate of overall intrahospital death was 46%. Death until last follow‐up occurred in 8/17 (47%) in the REP and in 7/11 (63%) of the NOREP group. Favorable outcomes were observed in 35.7% of the patients: 8/17 (47%) in REP and in 2/11 (18.1%) in NOREP. NIH stroke scale scores were significantly lower in patients with favorable outcomes. Intracranial hemorrhage was observed in 6/28 (21.4%) of the patients (all in REP group). Twenty patients were treated with anticoagulants within the first 24 h. No hemorrhage was observed in those treated with enoxaparin, while three occurred in subjects treated with unfractionated heparin. Conclusion: Together with other series, our results underscore the relevance of NIH stroke scale at admission as a prognostic marker, the importance of reperfusion to improve outcomes, and the need of clinical trials to compare the impact of treatment with anticoagulants within first 24 h in basilar artery occlusion. [ABSTRACT FROM AUTHOR]