Objective To investigate the clinical efficacy and safety of probucol combined with atorvastatin in treatment of carotid atherosclerotic plaque in very old patients. Methods Sixty very old patients (≥80 years old) with carotid atherosclerotic plaques identified by ultrasonography admitted in our department from January 2017 to December 2017 were recruited in this study, and then randomly divided into control group (n=30) and combined treatment group (n=30). Both groups of patients were given oral administration of atorvastatin, while those from the combined treatment group were treated with combination of probucol. The related clinical indices were recorded before and after 36 weeks′ treatment. SPSS statistics 19.0 was used to perform the statistical analysis. Chi-square test or Student′s t test was employed for comparison between the 2 groups based on different data types. Results The combined treatment group had significantly lower serum total cholesterol [(3.42±1.63) vs (3.83±1.34)mmol/L], triglycerides [(1.80±1.37) vs (1.95±1.65)mmol/L], low-density lipoprotein cholesterol [(2.13±1.32) vs (2.63±1.64)mmol/L], neuronal specific enolase [(9.48±6.78) vs (12.31±9.78)mmol/L] and high-sensitivity C-reactive protein [(3.42±1.36) vs (4.56±3.36)mmol/L], but obviously higher high-density lipoprotein cholesterol [(1.64±1.01) vs (1.43±1.12)mmol/L] when compared with the control group (all P<0.05). There was no significant differences in all indices concerning safety before and after treatment in the both groups (P>0.05). Conclusion Probucol combined with atorvastatin effectively improves the resistance indices of carotid artery in very old patients, and shows obvious protective effects on oxidation damage and nerve damage with good clinical safety.