The occurrence of significant carotid artery disease in patients requiring coronary artery bypass grafting (CABG), results in a dilemma regarding the best surgical management. Our philosophy has been to perform simultaneous carotid endarterectomy and CABG off-pump. We reviewed the efficacy of this therapy in six patients treated in our hospital between January 2001 and December 2002. The result was satisfactory and there was no hospital mortality.