To compare the clinical effect of endovascular stenting and medicinal intervention in symptomatic middle cerebral artery stenosis (MCAS). Methods: Seventy patients with symptomatic MCAS were enrolled. The patients were randomly divided into the stent group and drug group, with 35 cases in each. The stent group was treated with sent angioplasty and antithrombotic drugs after operation. The drug group was treated with antithrombotic drugs, lipid-lowering drugs, and antihypertensive drugs. The incidence of stroke and death were compared between the two groups at 1 month, 6 months, and 1 year after treatment. The stenosis rate, modified Rankin (mRS) score, National Institutes of Health Stroke Scale (NIHSS) score, systolic blood pressure (SBP), diastolic blood pressure (DBP), HbA1c, total cholesterol (TC), peak systolic velocity (PSV), end-diastolic velocity (EDV), and pulsatility index (PI) were compared between the two groups before and after treatment. Re? sults: One year after treatment, the incidence of stroke in the stent group was 8.57%, which was significantly lower than the 28.57% of the drug group (P<0.05). The stenosis rate, mRS score, and NIHSS score in the stent group were significantly lower than before treatment and after treatment in the drug group (P<0.05). The SBP, DBP, HbA1c, and TC in both groups were significantly lower than those before treatment (P<0.05) but showed no significant difference when comparing the groups with each other. After treatment, PSV and EDV in the stent group were significantly lower than those before treatment and after treatment in the drug group, and PI was significantly higher than those before treatment and after treatment in the drug group (P<0.05). Conclusion: Endovascular stenting has better long-term clinical effect in the treatment of symptomatic MCAS than simple medicinal therapy and can better improve nerve function and cerebral blood flow velocity.