Vertebral artery revascularization is indicated for symptomatic vertebral artery disease. Safe and effective revascularization can be offered to such patients with good long-term outcomes. Percutaneous transluminal angioplasty, with and without stents, may eventually develop a role. However, prospective trials to compare angioplasty with the safety and long-term efficacy of surgical revascularization are needed before any benefit can be assumed.