Perioperative stroke and ischemic encephalopathy are two well recognized complications of coronary artery bypass grafting (CABG).Surgical treatment of simultaneous coronary carotid disease is still controversial.Carotid artery stenting (CAS) is being investigated as an alternative treatment to carotid endarterectomy (CEA).The safety of CAS has been particularly strengthened with the routine use of distal protection devices.There should be a protocol for use of antiplatelet drugs before and after CAS and after CABG.