Background and Aims: Symptomatic vertebral artery stenosis has been associated with high risk of recurrent stroke, particularly in the first few weeks after symptoms, with higher risks for intracranial (IC) than extracranial (EC) stenosis. Vertebral artery stenosis can be treated with stenting with good technical results, but a higher periprocedural risk has been reported for IC than EC stenosis. We performed an individual patient pooled analysis of RCTs comparing vertebral stenting with medical treatment for symptomatic vertebral stenosis. Methods: Data were included from VIST (N = 179, EC 148, IC 31), VAST (N = 115, EC 96, IC 19) and SAMMPRIS (IC 60, no EC). Cox regression was performed stratified by trial. The primary outcome was any fatal or nonfatal stroke during follow-up. A further analysis was performed for patients randomised within 14 days of last symptoms. Results: The hazard ratio (HR) for any stroke in the stenting arm compared with the medical arm was 0.81 (95% CI 0.45-1.44). For EC alone it was 0.63 (0.27-1.46), and for IC alone 1.06 (0.46-2.42). For patients randomised within 14 days of last stroke/TIA the HRs were: all 0.65 (0.31-1.39), EC only 0.56 (0.17-1.87), IC only 0.72 (0.27-1.90). Conclusions: This pooled analysis of available data from completed vertebral artery stenting trials did not show a statistically significant benefit for either medical or interventional therapy. There was no evidence of even a trend of benefit of either strategy for IC stenosis. Stenting for EC stenosis might be beneficial, but further larger trials are required to determine whether there is benefit in this subgroup. Trial registration numbers: SAMMPRIS:NCT00576693; VAST:ISRCTN29597900; VIST:ISRCTN95212240.