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Introduction Current recommendations regarding the best treatment approach for patients with severe atherosclerotic vertebral artery ostial stenosis (VAOS) are insufficient. Even with optimal medical treatment and effective risk factor management, substantial numbers of patients experience symptoms or recurrent strokes. Endovascular treatment is a potential solution, particularly when medicinal therapy alone is insufficient for symptom and stroke risk reduction. This study was aimed at assessing the safety and effectiveness of stent angioplasty in patients with VAOS.Aim of Study To assess the safety and efficacy of stent angioplasty as a treatment option in patients with VAOSMethod This single-center retrospective analysis included 564 procedures in 525 patients (asymptomatic n = 260, symptomatic n = 265; 72.2% male; median age: 70 years; stenosis >75% n = 371) who underwent stenting for atherosclerotic VAOS between 2008 and 2022. Vertebrobasilar tandem lesions and dissections were excluded. Digital subtraction angiography (DSA) was performed in all patients during a 1-year follow-up. Patients’ characteristics, peri- and postprocedural neurological events, and follow-up data were evaluated. The primary endpoint was any ischemic stroke within the 1-year follow-up.Abstract A78 Figure 1Results Stenting was successfully performed in all cases. The overall stroke rate was 0.6% (disabling n=2; non-disabling n=1). No treatment-associated deaths occurred. In-stent restenosis >50% was found in 70 (12.4%) implanted stents in the 1-year DSA follow-up within a mean of 6.2 months.Abstract A78 Figure 2Conclusion Stent angioplasty in patients with VAOS was demonstrated to be a safe and feasible option, with a low risk of periprocedural stroke and favorable stent patency rates at midterm follow-upConflict of Interest No