Endovascular treatment of vertebral artery stenosis (VAS) is a safe and effective technique for treating symptoms caused by posterior circulation ischemia with high technical and clinical success rates, low complication rates and durable long-term results. Variable restenosis rates have been reported in the literature with small improvements demonstrated using drug eluting stents. Although there is insufficient evidence from randomized trials to demonstrate superiority of endovascular compared to optimal medical therapy for the treatment of this disease, patients who fail medical therapy should be considered for endovascular stenting for symptomatic VAS. This manuscript will examine and review the endovascular treatment options for extracranial VAS. (C) 2017 Elsevier Inc. All rights reserved.