<p>Anomalous origin of the vertebral artery from the common carotid artery is a rare vascular variation, often associated with other aortic arch anomalies. We report the case of a 39-year-old woman who presented with acute dizziness and was diagnosed with a cerebellar infarction. Initial Computed tomography angiography revealed a right vertebral artery arising from the right common carotid artery, in conjunction with an aberrant right subclavian artery originating as the last branch of the aortic arch. A follow-up examination identified a de novo aneurysm in the V1 segment. The patient underwent successful endovascular treatment with a flow diverter device, resulting in complete aneurysm occlusion and symptom improvement. This case highlights the clinical relevance of recognizing complex vertebral and subclavian artery anomalies, which may complicate diagnosis and neurointerventional management.</p>