This study aimed to evaluate the clinical outcomes of a combined surgical approach involving carotid endarterectomy (CEA) and carotid artery stenting (CAS) for the management of patients with severe bilateral carotid atherosclerotic stenosis.A retrospective analysis was conducted on the clinical data of 19 patients diagnosed with severe bilateral carotid artery stenosis who were hospitalized between June 2019 and January 2022. The efficacy of the combined CEA and CAS approach was analyzed.Postoperative imaging confirmed complete resolution of stenosis, restored lumen patency, and substantial improvement in intracranial hypoperfusion across 38 stenotic sites in the 19 patients. No serious complications were observed during the perioperative period. At the 3-month follow-up, none of the patients experienced cerebrovascular events, and symptoms of preoperative cerebral ischemia revealed varying degrees of improvement. The modified Rankin Scale (mRS) score was ≤2 in all patients, with a mean score of 1.52±0.18. Over a follow-up period extending up to 48 months, no recurrence of stroke or severe complications was reported.The choice of surgical intervention for patients with severe bilateral carotid artery stenosis should be tailored to the clinical profile of each patient. The combined approach of CEA and CAS integrates the advantages of both techniques, reduces the risk of postoperative complications, and enhances the range of therapeutic options available for this population.Copyright © 2025 by Mutaz B. Habal, MD.