<?xml version="1.0"?>
<ownershipDocument>

    <schemaVersion>X0508</schemaVersion>

    <documentType>4/A</documentType>

    <periodOfReport>2026-02-02</periodOfReport>

    <dateOfOriginalSubmission>2026-02-04</dateOfOriginalSubmission>

    <issuer>
        <issuerCik>0001408443</issuerCik>
        <issuerName>Milestone Pharmaceuticals Inc.</issuerName>
        <issuerTradingSymbol>MIST</issuerTradingSymbol>
    </issuer>

    <reportingOwner>
        <reportingOwnerId>
            <rptOwnerCik>0001437782</rptOwnerCik>
            <rptOwnerName>Oliveto Joseph</rptOwnerName>
        </reportingOwnerId>
        <reportingOwnerAddress>
            <rptOwnerStreet1>C/O MILESTONE PHARMACEUTICALS INC.</rptOwnerStreet1>
            <rptOwnerStreet2>1111 DR. FREDERIK-PHILIPS BLVD, STE 420</rptOwnerStreet2>
            <rptOwnerCity>MONTREAL</rptOwnerCity>
            <rptOwnerState>A8</rptOwnerState>
            <rptOwnerZipCode>H4M 2X6</rptOwnerZipCode>
            <rptOwnerStateDescription>QUEBEC, CANADA</rptOwnerStateDescription>
        </reportingOwnerAddress>
        <reportingOwnerRelationship>
            <isDirector>true</isDirector>
            <isOfficer>true</isOfficer>
            <isTenPercentOwner>false</isTenPercentOwner>
            <isOther>false</isOther>
            <officerTitle>President and CEO</officerTitle>
            <otherText></otherText>
        </reportingOwnerRelationship>
    </reportingOwner>

    <aff10b5One>0</aff10b5One>

    <nonDerivativeTable></nonDerivativeTable>

    <derivativeTable>
        <derivativeTransaction>
            <securityTitle>
                <value>Employee Stock Option (right to buy)</value>
            </securityTitle>
            <conversionOrExercisePrice>
                <value>1.96</value>
                <footnoteId id="F1"/>
            </conversionOrExercisePrice>
            <transactionDate>
                <value>2026-02-02</value>
            </transactionDate>
            <transactionCoding>
                <transactionFormType>4</transactionFormType>
                <transactionCode>A</transactionCode>
                <equitySwapInvolved>0</equitySwapInvolved>
            </transactionCoding>
            <transactionAmounts>
                <transactionShares>
                    <value>679000</value>
                </transactionShares>
                <transactionPricePerShare>
                    <value>0</value>
                </transactionPricePerShare>
                <transactionAcquiredDisposedCode>
                    <value>A</value>
                </transactionAcquiredDisposedCode>
            </transactionAmounts>
            <exerciseDate>
                <footnoteId id="F2"/>
            </exerciseDate>
            <expirationDate>
                <value>2036-02-02</value>
            </expirationDate>
            <underlyingSecurity>
                <underlyingSecurityTitle>
                    <value>Common Shares</value>
                </underlyingSecurityTitle>
                <underlyingSecurityShares>
                    <value>679000</value>
                </underlyingSecurityShares>
            </underlyingSecurity>
            <postTransactionAmounts>
                <sharesOwnedFollowingTransaction>
                    <value>679000</value>
                </sharesOwnedFollowingTransaction>
            </postTransactionAmounts>
            <ownershipNature>
                <directOrIndirectOwnership>
                    <value>D</value>
                </directOrIndirectOwnership>
                <natureOfOwnership>
                    <value></value>
                </natureOfOwnership>
            </ownershipNature>
        </derivativeTransaction>
    </derivativeTable>

    <footnotes>
        <footnote id="F1">The exercise price on the initial filings was incorrectly stated.</footnote>
        <footnote id="F2">One-fourth (1/4th) of the shares subject to the option vest on February 2, 2027, and one thirty-sixth (1/36th) of the remaining shares subject to this option shall vest each month thereafter, subject to the Reporting Person continuing to provide service through each such date.</footnote>
    </footnotes>

    <ownerSignature>
        <signatureName>/s/ Joseph Oliveto</signatureName>
        <signatureDate>2026-02-05</signatureDate>
    </ownerSignature>
</ownershipDocument>
