Symptomatic and asymptomatic carotid stenosis was shown in 31 patients with severe coronary artery disease referred for myocardial revascularization. The operative sequence of carotid repair before coronary surgery was elected in 15 patients. Three patients died of myocardial complications after carotid endarterectomy and before coronary surgery could be carried out. Combined carotid endarterectomy and coronary revascularization was carried out in 16 patients, with no mortality and minimal morbidity. Cerebral complications were infrequent, and only one mild neurologic deficit could be related to cardiopulmonary bypass. Simultaneous carotid endarterectomy and coronary revascularization was the most effective means for avoiding myocardial complications and reducing the potential neurologic deficits.