Ipsilateral vertebral artery injuries are a rare entity following trauma to the neck. We discuss the first case of an isolated right vertebral artery injury in a patient with a left stab wound. The patient required bilateral neck explorations and, due to massive bleeding, a median sternotomy in order to obtain control of the proximal segment of the right vertebral artery. We emphasize the importance for trauma surgeons to be familiar with basic but important vascular exposures. The anatomy, surgical exposure, and management of these rare injuries are discussed.