Aim. To evaluate the effectiveness of endovascular stent therapy and drugs for 21 patients with bilateral severe carotid stenosis, and to observe the middle and short term follow-up results of stroke after intervention treatment. Methods. 21 patients with bilateral severe carotid stenosis were divided into two groups randomly. Group A (8 patients) were treated with endovascular stent approach, and Group B (13 patients) were treated with drugs. All patients were examined physically and checked by duplex ultrasound of carotid in a follow-up way in 18 months. Results. Group A: all 8 procedures succeeded, the stenotic degree of the lesions before procedures was 70%-98%, and the residual stenosis after procedures were less than 10%. Except one patient had TIA once, neither new stroke nor TIA had happened. Group B: Stroke had happened in 9 patients (4 patients had TIA, 2 patients died). Other (4 patients) had not changed. Results of carotid ultrasound in 7 patients (7/11) showed that the carotid inner-middle membrane thickness was significantly increased, the size and rank of carotid artery atheromatous plaque was significantly increased, carotid stenosis extent deteriorated. Conclusion. Endovascular stenting approach is more effective than drug treatment for patients with bilateral severe carotid stenosis in a short or middle term.