Coronary and carotid atherosclerosis are often coexistent in the same patient. Therefore, patients presenting with carotid stenosis should be screened for coronary heart disease and vice versa. Patients with significant asymptomatic or symptomatic carotid stenosis have an elevated perioperative risk of cerebral ischemic attacks during operations with extracorporeal circulation and of myocardial infarction during carotid endarterectomy. The operations should be performed simultaneously, with carotid endarterectomy being done before sternotomy. This yields mortality and morbidity rates comparable with those for isolated operations on extracorporeal circulation. Medical therapy for such patients consists of platelet inhibitors with adequate cardiac medication.