Traumatic vertebral artery injury (TVAI) is a rare but severe pathology which can be associated both with penetrating injury of the neck and blunt or unclassified injury. Injury of the vertebral artery, especially due to gunshot or knife wounds, causes severe condition of the patients, development of a wide spectrum of complications including life-threatening, high rates of disabilities and mortality.There is no consensus on the treatment tactics for this pathology. Open surgery as the first stage of surgical intervention can be used in a limited number of cases. X-ray endovascular techniques of TVAI treatment are considered to be preferable.We present a clinical case of a 27‑year-old patient with TVAI caused by a penetrating gunshot wound of the neck and complicated by formation of a giant pseudoaneurysm of the V3 segment of the vertebral artery. Two-stage combination treatment of TVAI was performed using endovascular and open surgical techniques.Descriptions of TVAI cases are rare, and further accumulation and analysis of corresponding data and proposals on treatment of the patients with TVAI will help to formulate precise algorithms of doctors’ actions and optimize treatment tactics.