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A 68-year-old man, six months after L-ICA C4 multiple aneurysms with Pipeline implantation and the origin of L-VA stenting. Angiography showed good occlusion of L-ICA C4 aneurysms; however, the patient also suffered a stent fracture, restenosis of L-VA origin, and progressive stenosis of R-VA origin. In addition, the R-ICA of this patient was also occlusion, and we can see good reflux of the distal internal carotid artery up to the C1 segment. After discussion with the team, recanalization of the R-ICA will be tried, and both vertebral artery stenting will also be performed.