Patients who present with concomitant coronary artery disease and hemodynamically significant carotid artery occlusive disease represent a subset of individuals at high risk for myocardial infarction and stroke. Whether the combined surgical approach favorably influences the outcome of patients requiring major cardiovascular surgical procedures remains controversial. However, it is clear that coronary artery bypass procedure and carotid endarterectomy are each beneficial to patients who have the appropriate indications for each procedure individually. The coincidence of carotid and coronary occlusive disease varies with the type of diagnostic tests involved. Angiographic data suggest a coincidence in the range of 1 to 6 per cent, while vascular laboratory screening data in some studies have indicated a coincidence as high as 12 to 14 per cent--a range that appears to be higher than one might expect from clinical experience. It is clear from analyzing the patient profile of this subset of patients from large clinical reviews that in general they are older and sicker and have a higher incidence of cardiovascular risk factors representing more extensive atherosclerosis. It is also well documented that the neurologic complication rate for all patients undergoing coronary bypass is in the range of 2 per cent. Therefore, it should not be expected that the operative mortality rate and risk of perioperative stroke in patients undergoing the combined reconstructive procedure can equal those for either procedure alone. These patients represent a separate clinical subset at higher risk for perioperative complications and need to be evaluated individually.