Whether bilateral carotid atherosclerosis with plaque is serious or not depends on the nature and size of the plaque. If it is a stable plaque and has not led to luminal narrowing, it is not considered serious, while it is considered serious if it is an unstable plaque or has led to luminal narrowing. Carotid atherosclerosis is a non-inflammatory, degenerative and proliferative arterial disease that leads to thickening, hardening and loss of elasticity of the arteries, ultimately leading to narrowing of the lumen, and is most common in the elderly. If bilateral carotid atherosclerosis forms plaques that do not cause stenosis and the plaques are stable, then it is not considered serious, and active control of risk factors, such as hypertension, diabetes mellitus, hyperlipidemia, and smoking is sufficient. If the plaque is unstable or has led to lumen narrowing, then it is considered serious because unstable plaque may fall off at any time leading to ischemic cerebrovascular events; carotid artery stenosis can affect the blood supply to the brain, which can also lead to ischemic cerebrovascular disease episodes. Drug therapy, such as aspirin, atorvastatin and other anti-platelet aggregation and plaque stabilization therapy is needed. When bilateral carotid atherosclerosis with plaque is found, it is recommended to consult a specialized physician to choose the appropriate treatment plan according to the specific situation.