Objective To investigate the endovascular treatment strategies and short-term efficacy of intracranial vertebral artery dissecting aneurysms based on imaging classification. Methods This retrospective study included 42 patients with 45 intracranial vertebral artery dissecting aneurysms treated at Neurosurgery Department of Nanfang Hospital, Southern Medical University between January 2008 and March 2017. A new imaging classification system was employed according to the anatomical relationship between the lesion and the posterior inferior cerebellar artery (PICA), in which the lesion located distal to the PICA was defined as type Ⅰ. If the PICA was involved in the lesion segment, it was defined as type Ⅱ (type Ⅱ a: the same side; type Ⅱ b: separated into opposite sides). Type Ⅲ was defined if the lesion was proximal to the PICA. According to clinical symptoms, vertebral artery dominance, and imaging classification, simple stenting (SO), stent-assisted coil embolization (SAC) or parent artery occlusion (PAO) was applied. Results Thirteen cases with 14 aneurysms were classified as type Ⅰ, and 4 out of them were treated with SAC, 8 with PAO and 2 with SO. Eighteen cases with 19 aneurysms were classified as type Ⅱ a, and 9 out of them were treated with SAC, 7 with PAO, 3 with SO. Seven cases with 7 aneurysms were classified as type Ⅱ b, and 5 out of them were treated with SAC, 1 with PAO and 1 with SO. Four cases with 5 aneurysms were classified as type Ⅲ, and 4 out of them were treated with SAC and 1 with SO. There were 2 cases of intraoperative rupture and both died. Five (11.9%) cases developed new cerebral infarction within perioperative period. At discharge, grade Ⅴ was reported in 31 cases based on Glasgow outcome scale, grade Ⅳ in 4, grade Ⅱ in 5 and grade Ⅰ in 2 cases. The follow-up period was 3-48 months. There were no new neurological deficits. Twenty-two cases underwent follow-up DSA which reported cure in 20 cases and recurrence in 2. Conclusion Based on clinical symptoms, vertebral artery dominance and imaging classification, individualized endovascular treatment strategy seems to be safe and effective in the treatment of vertebral artery dissecting aneurysms. Key words: Vertebral artery; Aneurysm, dissecting; Angioplasty; Imaging classification