The posterior circulation, also known as the vertebrobasilar system, consists of the vertebral artery, the basilar artery, and the posterior cerebral artery, which mainly supplies blood to the brainstem, cerebellum, thalamus, occipital lobe, and part of the superior spinal cord. Posterior circulation ischemia is the most common ischemic cerebrovascular disease, accounting for approximately 20% of ischemic strokes. Major clinical manifestations of posterior circulation ischemia: common symptoms of posterior circulation ischemia: dizziness/vertigo, limb/head and face numbness, limb weakness, headache, vomiting, transient loss of consciousness, visual disturbance, unstable walking or fall. Common signs of posterior circulation ischemia: eye movement disorders, limb paralysis, sensory abnormalities, gait/limb ataxia, dysarthria/swallowing disorders, visual field defects, hoarseness, Homer syndrome, etc. The presence of crossover between cerebral nerve damage on one side and motor-sensory damage on the other side is a characteristic manifestation of posterior circulation ischemia. Acute treatment of posterior circulation ischemia: There is a lack of results from randomized controlled studies of samples specifically targeting posterior circulation ischemia; therefore, the acute management of posterior circulation ischemia is the same as for anterior circulation stroke. The organized treatment model of the stroke unit is extremely well developed. Intravenous thrombolytic therapy with recombinant tissue-type lysogen activator (rt-PA) can be performed in appropriate patients within 3 h of onset. The treatment window can be relaxed for those who are eligible for intravenous thrombolysis. For all those who are not suitable for thrombolytic therapy and have no contraindication, they should be treated with aspirin 100-300 mg/d. Other drugs such as Chinese herbs and nerve nutrients can be used. Prevention can be done with antiplatelet agents alone or in combination.