The rates for postoperative stroke and death for carotid endarterectomy and for CABG, independent of or in conjunction with one another, vary considerably in different patient populations (eg, young versus old, male versus female, etc.). More than half of all post-CABG strokes occur after uneventful recovery from CABG and are believed to be caused by supraventricular arrhythmias, low cardiac output, or postoperative hypercoagulability.863 A substantial proportion of post-CABG strokes occur in patients without significant carotid artery disease or in an anatomic distribution not consistent with a known significant carotid arterial stenosis. Advances in technologies for carotid and coronary revas- cularization make the decision-making process for the proce- dures even more complex. In addition to conventional CABG with CPB, the surgeon may choose an off-pump technique in certain patients (eg, those with a heavily calcified ascending aorta). Likewise, carotid artery stenting provides an alterna- tive to endarterectomy, which may reduce the risk of postop- erative stroke. Still, the ultimate impact of such stenting on postoperative stroke rates in CABG patients awaits the results of properly designed trials. At present, carotid artery stenting is reserved for CABG patients in whom a contraindication to open endarterectomy exists. When combined carotid and coronary revascularization is indicated, an awareness of the stroke and mortality rates for different patient subgroups will help to guide decision mak- ing. 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. 