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Introduction and Purpose Vertebrobasilar insufficiency causes postural induced ischemia, causing recurrent positional vertigo, ataxia, and near-syncope. While prior studies have focused on functional recovery and quality of life, patient-reported orthostatic symptom improvement following vertebrobasilar stenting remains underreported. We assessed patients using a structured upright posture intolerance questionnaire undergoing endovascular treatment for symptomatic vertebrobasilar stenosis pre and post intervention.Materials and Methods Two patients (aged 67 and 80 years) with symptomatic vertebrobasilar stenosis underwent percutaneous transluminal angioplasty and drug-eluting stent placement. Case 1: 67-year-old male with peripheral vascular disease and hypertension presented with vertigo, dysarthria, and visual changes. Magnetic resonance imaging (MRI) showed infarcts in bilateral cerebellum, left pons, right occipital cortex. Digital subtraction angiography (DSA) showed near total occlusion of basilar artery. Patient underwent percutaneous transluminal angioplasty with stenting (PTAS) with Resolute Onyx™ drug-eluting stent. Case 2: 80-year-old female with hypertension presented with persistent vertigo and gait instability. MRI demonstrates infarcts in the right thalamus, bilateral cerebellum, and right occipital cortex. Computed Tomography Angiography (CTA) revealed severe right vertebral artery (V4) stenosis with chronic left vertebral artery occlusion. DSA confirmed 90% stenosis in the right V4 vertebral artery segment. Patient underwent PTAS with XIENCE Skypoint™ Stent of right V4 segment of vertebral artery. Both patients received dual antiplatelet therapy (aspirin 81 mg, clopidogrel 75 mg). A structured, patient-reported outcome instrument was designed to quantify orthostatic tolerance and improvement pre and post intervention, consisting of five domains: (1) Duration of unsupported standing, (2) Presence of orthostatic symptoms (dizziness, lightheadedness, nausea) upon sitting after prolonged standing, (3) Recovery time to resume comfortable standing, (4) Ability and speed of postural transitions, and (5) Self-assessment scale for ability to perform routine household activities rated on a scale of 0-100. First three domains categorized as not at all, <5 minutes, 5-29 minutes, or ≥30 minutes)Results Both procedures were completed without periprocedural complications, symptomatic intracranial hemorrhage, access site complications, or neurological deterioration. Follow-up angiography demonstrated improved vessel caliber without in-stent stenosis. Patient-reported outcomes showed marked improvement across all questionnaire domains. Standing tolerance improved from 0 minutes to >30 minutes (Case 1) and 5-29 minutes to 5 minutes (Case 2). Daily activity scores increased from 60 to 80 (Case 1) and 30 to 50 (Case 2) on a 0-100 scale. At 2-month follow-up, both patients reported sustained symptom resolution with improved ability to perform household activities and maintain upright posture without dizziness.Conclusions Endovascular stenting of symptomatic vertebrobasilar stenosis resulted in significant orthostatic symptom improvement as measured by structured upright posture intolerance questionnaire. Improvement in ability to maintain upright posture without recurring dizziness represents an important effective measure for vertebrobasilar intervention. This patient-reported outcome measure provides a practical method to quantify clinical recovery beyond traditional angiographic and stroke recurrence endpoints, demonstrating the utility of targeted intervention in alleviating posture-related limitations from vertebrobasilar insufficiency.Disclosures V. Kaur: None. H. Tolba: None. S. Gillani: None. A. Qureshi: None.