Abstract
BACKGROUND: Vertebral artery injury (VAI) is a rare but serious condition, with an incidence of 0.24%-2% following blunt trauma and 1%-6% after penetrating injuries. Often asymptomatic, VAI carries significant risks, including ischemic strokes and severe neurological deficits, with symptoms appearing up to 6 months postinjury. OBSERVATIONS: A 64-year-old man experienced a critical neck injury from rebar penetration, resulting in hemorrhagic shock. Imaging revealed a left C3-4 fracture, vertebral artery (VA) transection, pseudoaneurysm, and arteriovenous fistula. Coil embolization was attempted but failed, necessitating stent placement and balloon dilation to restore VA patency. Postprocedure MRI revealed an epidural hematoma without spinal cord involvement. Surgical decompression and fixation were performed the next day, followed by dual antiplatelet therapy. The patient was discharged on day 13 without neurological deficits, and in-stent stenosis was successfully treated with balloon dilation 1 year later. LESSONS: This case highlights the successful treatment of a Denver scale grade V transected VAI using stent placement, emphasizing the importance of VA reconstruction as the primary treatment goal. https://thejns.org/doi/10.3171/CASE24557.