We reported a 37-year-old man who developed vertigo, dysarthria and left hemiparesis following neck pain. Magnetic resonance imaging (MRI) demonstrated infarct in the right superior cerebellar artery (SCA) territory. Duplex color-flow imaging detected dissection (double lumen) in the right vertebral artery (VA) at the level of the C4-C6 vertebra (V2 segment). Cerebral angiography showed irregular narrowing in the right V2, and occlusion of the right SCA. These findings suggested that dissection in the right V2 caused artery-to-artery embolism in the right SCA. Despite administration of anti-thrombotic agents, he recurrently suffered from transient ischemic attacks. Serial duplex color-flow imaging echography revealed that the dissection of the right VA gradually became more stenotic and extended to the distal site. Coil-embolization of the right VA by endovascular therapy was performed, and thereafter the dissecting lesion of the right VA was completely occluded and ischemic attacks disappeared.