Background: Atherosclerosis is a generalized disease, and while symptoms may be sitespecific, inevitably disease elsewhere will influence the overall management of a patient. Manypatients that underwent carotid endarterectomy died from IHD complications (e.g. myocardialinfarction), and vice versa as many patients that underwent CABG died from CVS and itscomplications. For this reasons we studied the special relation between severe coronary andcarotid artery disease.Patients and methods: This study recruited 1516 patients underwent or scheduled forCABG, divided into two main groups. The retrospective group included 794 patients, 719males (90.6%) and 75 females (9.4%). Mean age was 54.8 ± 10.6 ranging between 32 and 83years. This group had data about age, sex and carotid duplex. The prospective group included722 patients. Mean age was 57.4 ± 8.4 ranging between 36 and 80 years, 543 were males(75.2%) and 179 were females (24.8%). This group had data about age, sex, risk factors foratherosclerosis (smoking, HTN, DM, dyslipidemia and +ve family history of CAD) andassociated disease (TIAs, CVS, PVD and renal dysfunction). In 440 patients from theprospective group, data bout left ventricular systolic function, mode of presentation anddetailed coronary angiography were available. All patients were classified into three subgroupsaccording carotid duplex: subgroup 1: those have carotid stenosis ≥ 70% in either side,subgroup 2: those have carotid artery stenosis insignificant (< 70%) or IMT is > 1mm in eitherside and subgroup 3: those with normal carotid artery i.e. no plaques and IMT is ≤ 1mm in bothsides).Results: Severe carotid artery stenosis (≥ 70%) was detected in 31 patients (2.1%) of thewhole patients, in the retrospective group they were 12 (1.5%) and in the prospective groupthey were 19 patients (2.6%). Smoking is the strongest predictor for severe carotid arterystenosis, as it increases the risk by 13 times more than non-smoker, HTN also is a strongpredictor as it increases the risk by 6 times than normo-tensive, CVS also is a strong predictoras it increases the risk by 5 times than patients without CVS, significant LM lesion is apredictor as it increases the risk by 3 time more than those with normal LM, male gender is apredictor as it increases the risk by 2 times than female gender and finally, elderly age (≥ 60years) is the poorest predictor as it increases the risk by 20%.Conclusions: Severe carotid artery stenosis was detected in 2.1% patients with multi-vesselCAD. Smoking is the strongest predictor for severe carotid artery stenosis in patients withmulti-vessel CAD, as it increases the risk by 13 times, followed by HTN, history of CVS,significant LM coronary lesion, male gender and advanced age (≥ 60 years).