The Vertebral Artery

Written by Dr Oliver Jones

Last updated March 30, 2026
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The Vertebral Artery - Podcast Version

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The vertebral artery is one of a pair of vessels that forms a crucial component of the arterial supply to the brain.

Together, the vertebral arteries contribute to the posterior circulation – supplying the brainstem, cerebellum and posterior aspects of the cerebrum.

In this article, we shall examine the anatomy of the vertebral artery – its course, supply and clinical relevance.

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Course

The vertebral artery arises from the first part of the subclavian artery within the root of the neck.

It ascends superiorly through the neck by passing through the transverse foramina of the cervical vertebrae (typically C6–C1). During this part of its course, it gives rise to small spinal and muscular branches, which supply surrounding structures.

After exiting the transverse foramen of C1, the artery passes posteromedially within the suboccipital triangle, looping posteriorly around the lateral mass of the atlas.

The vertebral artery then enters the cranial cavity via the foramen magnum. Here, it runs along the anteromedial surface of the medulla oblongata. During its intracranial course, several key branches arise:

  • Posterior inferior cerebellar artery
  • Posterior spinal artery
  • Anterior spinal artery

At the junction of the medulla and pons (the pontomedullary junction), the vertebral artery terminates by uniting with its contralateral counterpart to form the basilar artery.

Fig 1
Course of the vertebral artery within the neck.

Diagram illustrating the suboccipital triangle and the anatomical location of the vertebral artery.

Fig 2
The suboccipital triangle. It can be used to locate the vertebral artery, as shown on this illustration.

Supply

The vertebral artery supplies the following structures through its branches:

  • Anterior and posterior spinal arteries – supply the superior spinal cord.
  • Posterior inferior cerebellar artery – supplies the cerebellum and lateral medulla oblongata.
  • Medullary branches – supply the medulla oblongata.
  • Meningeal branches – supply the dura mater.
  • Basilar artery – contributes to the supply of the posterior cerebrum.
Clinical Relevance

Vertebral Artery Dissection

A vertebral artery dissection is a tear in the inner lining of the vessel, allowing blood to track within the arterial wall. This can result in luminal narrowing, thrombus formation and subsequent ischaemia of posterior circulation structures.

The vertebral artery is particularly vulnerable where its course is tortuous and mobile. After exiting the transverse foramen of C1, it lies within the suboccipital triangle – where it is susceptible to stretching and injury during neck rotation and extension.

Dissection may also occur following cervical spine trauma, particularly fractures involving the transverse foramina.

Patients typically present with neck pain or occipital headache, followed by features of posterior circulation stroke, such as dizziness, ataxia or visual disturbance.

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