BACKGROUND The optimal management of patients with concomitant carotid and coronary artery disease remains controversial currently. The purpose of this study was to evaluate the safety and efficacy of hybrid or staged revascularization by carotid artery stenting (CAS) and off-pump coronary artery bypass (OPCAB) in the treatment of these patients. METHODS From September 2006 to January 2011, 59 consecutive patients with carotid and coronary artery disease underwent either hybrid (n = 20) or staged (n = 39) CAS and OPCAB, the perioperative and long-term outcomes were analysed. The primary endpoint was the incidence of stroke, perioperative myocardial infarction (MI) or death within 30 days of the procedures. RESULTS No death occurred post-operatively. Two patients (2/20) in hybrid group and two patients (2/39) in staged group suffered from non-fatal stroke. The combined incidence of stroke, MI or death at 30 days was 10.0% in hybrid group and 5.1% in staged group (P = 0.875). The median follow-up time was 44 months (range, 28 to 80 months) with 57 patients (96.6%) available. During follow-up period, one patient had non-fatal stroke in hybrid group and one patient suffered from MI in staged group, respectively. There was no significant difference of long-term event-free survival between the two groups (log-rank test, P = 0.390). CONCLUSIONS Our findings demonstrate that for patients with carotid and coronary artery disease, both hybrid and staged revascularization by CAS and OPCAB are feasible and safe therapeutic strategies with good early and long-term outcomes. However, our results have to be substantiated by larger scale studies and randomized trials.