Infarction of the symmetrical middle cerebellar peduncles is often induced by ischemic cerebrovascular disease. Adams described the anterior inferior cerebellar artery (AICA) syndrome as early as 1943, but clinical and imaging studies following this failed to shed more light regarding the condition until the advent of magnetic resonance imaging that comprehension regarding AICA improved significantly. Infarction of the middle cerebellar peduncles (MCP) is uncommon and the endovascular treatment of this condition is even more rare. We studied 4 patients with simultaneous bilateral cerebellar infarction of whom 2 received intracranial vascular therapy and demonstrated improvement in symptoms. Our findings suggest that patients with vertebral basilar artery stenosis with potential bilateral cerebellar infarction may benefit from endovascular treatment.