Double-origin vertebral artery is an uncommon anatomic variation that may complicate both radiologic interpretation and surgical planning. In response to the recent case report by Triantafyllou et al. (2025), this correspondence primarily highlights the potential for diagnostic misinterpretation of this configuration on vascular imaging and proposes practical reporting considerations to reduce clinical error. In addition, the variant is briefly discussed within a broader embryological context of vertebral artery development, emphasizing that commonly cited developmental explanations are not mutually exclusive. Together, these perspectives aim to complement the original report by emphasizing imaging-related pitfalls and situating the anomaly within an accepted developmental framework relevant to spine surgeons, radiologists, and vascular specialists.
