Introduction: Traumatic involvement of the vertebral artery is extremely rare and difficult to diagnose. Objective: To provide clinical evidence by reviewing a case series. Materials and Method: We analyze four cases of penetrating trauma with involvement of the vertebral artery between 2020 and 2021, managed in the trauma and emergency unit of the Dr. Sótero del Río Care Complex. Results: Four clinical cases are presented describing diagnosis and management process. Discussion: There is little evidence of traumatic involvement of the vertebral artery. Recognizing its complex anatomy and varied clinic are transcendental for its proper management. When this type of lesion is suspected, computed tomography angiography is the choice study when hemodynamically stable. The range of therapeutic options include observation, antithrombotic or antiplatelet therapy, endovascular therapy or open surgery. Conclusion: Penetrating trauma of the vertebral artery is an uncommon condition, however, its diagnosis and management should be known to the surgeon.