Purpose: To evaluate the safety and efficacy of ultrasound-guided retrograde internal jugular venous (IJV) puncture in neurointerventional procedures. Materials and Methods: This single-centre retrospective study evaluates data collected over 20 years. All punctures were performed under general anaesthesia using ultrasound guidance. The data were analyzed to assess patient demographics, indications and potential advantages, the technique of puncture, safety, outcomes, and complications associated with such punctures. Results: The study included 60 patients (males: n=38, 63%; females: n=22, 37%). The median age was 33 years (range 13–73 years). A total of 74 retrograde jugular punctures were performed. Isolated right-sided punctures were done in 31 patients (52%), isolated left-sided punctures in 18 (30%), and 11 patients (18%) underwent bilateral punctures. The preferred access needle was an 18G needle; however, micropuncture access was used in some patients. No inadvertent arterial punctures were encountered. The most common indication was mechanical thrombectomy for cerebral venous thrombosis (62%). Other indications included transvenous embolization of carotid-cavernous fistulae (16%), embolization of cerebral dural arteriovenous fistulae (8%), inferior petrosal sinus sampling (8%), and cerebral venous sinus angioplasty or stenting (6%). In all procedures, the expected technical outcome was achieved. Conclusion Ultrasound-guided retrograde IJV puncture is a safe and effective method for accessing neurovascular pathologies requiring a transvenous approach. Based on our experience, this access has been routinely used without any major complications. We foresee the technique being accepted on a larger scale in the future.