The importance of the vertebral arteries is underscored by their role in vascularizing the entire posterior circulation. Vertebral artery pathologies can lead to a range of clinical manifestations, including syndromes related to infarctions of the medulla or lower cerebellum. Moreover, bilateral vertebral pathologies or extension into the basilar artery can result in pontine, mesencephalic, thalamic, occipital, or mesiotemporal lesions [1]. This review focuses on intrinsic stenosing and occlusive pathologies of the vertebral arteries that cause various neurovascular presentations. Aneurysmal lesions, arteriovenous fistulae, and extrinsic pathologies – namely, external structures compressing these vessels – are beyond the scope of this article.

In the absence of an official classification of vertebral artery pathologies, this review adopts a pragmatic approach, categorizing them based on whether they are intrinsic wall disorders or extrinsic compressions, as presented in Table 1.