Abstract: Objective To explore the safety and efficacy of drug-eluting stents (DES) and bare-metal stents (BMS) in the treatment of vertebral artery stenosis (VAS), as well as the influencing factors of in-stent restenosis (ISR). 
Methods From June 2022 to October 2023, 129 patients undergoing vertebral artery stent implantation in the Department of Neurosurgery, the First Hospital of Hebei Medical University were selected and randomly divided into the DES group and the BMS group using a randomized controlled method and followed up. The clinical data of the patients were recorded and they were divided into the stenosis group and the non-stenosis group according to occurrence of ISR after surgery. Through Logistic regression analysis, the risk factors affecting ISR were analyzed. 
Results All stents were successfully implanted, and there was no hematoma at puncture site, intracranial hemorrhage, or death events after surgery. The incidence of ISR in the DES group was significantly lower than that in the BMS group (4.84% vs. 28.36%, P＜0.05). Multivariate regression analysis confirmed that the BMS group was an independent risk factor for ISR (OR=0.10, P＜0.001, 95%CI:0.02-0.39). 
Conclusion Vertebral artery stent implantation is a safe and effective method for treating patients with symptomatic VAS who are poorly controlled by drugs, and DES can significantly reduce the incidence of ISR. 

Key words: vertebrobasilar insufficiency, in-stent restenosis, drug-elutingstent