The clinical case of the vertebral arteries pathology in a patient with bilateral Kimmerle anomaly with stable vestibular syndrome, rare syncope states, transient ischemic attacks in the anterior spinal artery, and pyramid insufficiency is presented. The prolonged conservative treatment has been inefficient. The vertebral arteries decompression at the level of the atlas performed in the Republic of Belarus for the first time has resulted in a good clinical postoperative outcome. A literature review of etiopathogenesis, clinical features, diagnosis, and choice of the adequate tactics for the pathology is given.