Several factors favor combined revascularization, includ- ing (but not limited to) 1) severe carotid artery disease, 2) unfavorable morphological characteristics of the carotid le- sion(s) (eg, ulcerated lesions), 3) the presence of related symptoms, and 4) a history of TIA or stroke. In those with a history of TIA or stroke who have a significant carotid artery stenosis (50% to 99% in men or 70% to 99% in women), the likelihood of a post-CABG stroke is high; as a result, they are likely to benefit from carotid revascularization.863 Con- versely, CABG alone can be performed safely in patients with asymptomatic unilateral carotid stenoses, because a carotid revascularization procedure offers no discernible reduction in the incidence of stroke or death in these individuals. Men with asymptomatic bilateral severe carotid stenoses (50% to 99%) or a unilateral severe stenosis in conjunction with a contralateral carotid artery occlusion may be considered for carotid revascularization in conjunction with CABG. Little evidence exists to suggest that women with asymptomatic carotid artery disease benefit from carotid revascularization in conjunction with CABG.864 Whether the carotid and coronary revascularization procedures are performed simul- taneously or in a staged, sequential fashion is usually dictated by the presence or absence of certain clinical variables. In general, synchronous combined procedures are performed only in those with both cerebrovascular symptoms and ACS. The optimal management of patients with coexisting ca- rotid artery disease and CAD is poorly defined. Several therapeutic approaches can be used, including staged carotid endarterectomy and CABG, simultaneous carotid endarterec- tomy and CABG, or similar variations that use endovascular stenting as the primary carotid intervention. 