【Abstract】 Objective To explore the effect of V1 segment of the vertebral artery on the technical indexes of vertebral artery stenting. Methods 256 cases of vertebral artery stenting were retrospectively analyzed. According to the angle between the V1 segment of vertebral artery and the distal segment of subclavian artery, the anatomical pathway of V1 segment of vertebral artery was divided into type I and type II. The angle between V1 segment of vertebral artery and distal segment of subclavian artery with long axis angle less than 90 ° was type I. The angle between V1 segment of vertebral artery and distal segment of subclavian artery with long axis angle > 90 ° was type II. The effect of anatomical variation of the 1 segment of the vertebral artery on the success rate of different operation paths, Xray exposure time, contrast agent dosage and operation related complications was analyzed. Results 223 cases ( 210 cases of type Ⅰ and 13 cases of type Ⅱ) were treated with stent placement for vertebral artery stenosis via femoral artery. The success rate of type Ⅰ patients was higher than that of type Ⅱ patients (P＜0.05 ). Compared with type Ⅱ patients, the exposure time and contrast dose of type Ⅰ patients were significantly reduced (P＜0.01 ). 30 cases (20 cases of type Ⅰ and 10 cases of type Ⅱ) of vertebral artery stenosis were treated by radial artery approach. The success rate of type Ⅰ patients was lower than that of type Ⅱ patients ( P＜0.05 ); Compared with type Ⅱ patients, the exposure time and contrast dose of type Ⅰ patients increased significantly ( P＜0.01 ). The incidence of complications in type Ⅱ patients treated with stent placement for vertebral artery stenosis via femoral artery was significantly higher than that in typeⅠpatients ( P＜0.05). Conclusion The morphological characteristics of V1 segment of vertebral artery affect the technical indexes of vertebral artery stenting. Stent placement for vertebral artery stenosis via femoral artery is the first choice for type Ⅰ patients, while for type Ⅱ patients, radial artery is firstchoice access.