Abstract
BACKGROUND: Traumatic vertebral artery injury (TVAI) is a serious yet underdiagnosed complication of cervical spine trauma, with an incidence ranging from 0.1% to 3.2%. While its neurological sequelae vary, the risk of vertebrobasilar ischemia can be as high as 33.3%. The authors present a rare case of bilateral vertebral artery occlusion with concomitant basilar artery occlusion following C4-5 anterolisthesis. OBSERVATIONS: The patient initially exhibited no clinical signs of vertebrobasilar ischemia. Diagnosis was achieved through vascular imaging, and successful endovascular thrombectomy with thrombus removal was performed. Unique to this case, manual cervical reduction was carried out in the endovascular suite while maintaining catheter placement in an effort to prevent recurrent dissection or emboli migration. LESSONS: Given the transient nature of vertebrobasilar ischemia, repeated imaging and neurological monitoring are crucial for timely intervention. This case highlights the importance of establishing standardized screening and treatment protocols to optimize outcomes and prevent further complications in patients with TVAI. https://thejns.org/doi/10.3171/CASE25155.