Endovascular vertebral artery occlusion including dissected site is currently very popular for the treatment of ruptured vertebral artery dissecting aneurysm (VADA). However, among the VADA cases previously treated in our hospital, we encountered two pitfalls in a postoperative course of endovascular treatment. One pitfall is an antegrade recanalization of a completely embolized vertebral artery, in particular cases with VADA distal to the origin of the posterior inferior cerebellar artery (PICA), therefore, we should carefully follow up in case of PICA-end appearance after endovascular treatment. Another pitfall is de novo VADA in an unaffected contralateral vertebral artery due to hemodynamic stress after internal trapping of a dissected vertebral artery. Taken these two pitfalls into consideration, a strict follow up angiography of bilateral vertebral arteries is necessary at the postoperative appropriate time such as 1 day, 2 weeks, 1, 3, 6, and 12 months following endovascular treatment for ruptured VADA.