Background:Patients suffering from a concomitant coronary and carotid artery occlusive disease represent a high-risk population whose management remains controversial.Methods:Between April 1979 and June 2002, 202 patients (163 men and 39 women, mean age 65± 7 years) were admitted at the Department of Cardiovascular Surgery of the University of Bologna for coronary artery bypass graft and carotid endarterectomy (CEA). In Group 1 (140 patients) coronary artery bypass graft and carotid endarterectomy were performed simultaneously while in Group 2 (62 patients) they were performed as two-staged procedures.Results:The rate of postoperative stroke was 6.4% in Group 1 (9/140) and 4.8% in Group 2 (3/62). Significant univariate predictors of myocardial infarction were smoking history and previous myocardial infarction; for stroke they were older, greater than 70 years, and a smoking history; for death the significant predictors were the operative approach, the low ejection fraction, smoking history, renal failure, and peripheral vascular occlusive disease. The hospital mortality was 6.4% in Group 1 versus 12.9% in Group 2.Conclusions:Despite the highly selected populations, the contemporary surgical results indicate that the management of these patients needs careful pre-, intra-, and postoperative assessment and timing aimed at reducing the ischemic injuries, both cerebral and cardiac, therefore we believe that the surgical technique should be individualized for each patient.(J Card Surg 2005;XX:XXX-XXX) [ABSTRACT FROM AUTHOR]