The objective of study was to improve the results of surgical treatment of patients with bilateral atherosclerotic lesions of the carotid arteries.Material and Methods: The study included 180 patients between the ages of 42 and 82 (mean age 59±5.6 yrs) who underwent surgical treatment for bilateral atherosclerotic lesions of the carotid arteries during 2008-2014. Depending on the surgical treatment tactic, a total of 180 patients were divided into two groups. Group 1 included 60 (33.3%) patients who underwent staged bilateral carotid endarterectomy (CEA). Group 2 included 120 (66.7%) patients, in whom the first stage of CEA was performed on the side of primary importance.Results: The differentiated approach for identification the side for the first stage CEA is very important. Our experience shows that the intervals between CEA on both sides should not exceed 3 months and should be no less than 3 weeks. This tactic reduces not only mortality and complications, but also significantly improves the patient life quality by promoting rapid regression of neurological deficit.