Cervical arterial dissections and dissecting aneurysms are relatively rare pathologies, but can be associated with significant morbidity from ischemic complications. We review the challenges in diagnosing cervical arterial dissections, their unique clinical presentations and imaging characteristics. Although the majority of cervical dissections heal spontaneously with medical management, we discuss the specific indications for surgical or endovascular treatment to prevent thromboembolic complications. Furthermore, we provide a detailed technical review on endovascular stent reconstruction, the primary interventional option for symptomatic cervical dissections and dissecting aneurysms refractory to medical management.