Objective To analyze the risk factors and prognosis of carotid artery stenosis (CAS) in patients who under?went off-pump coronary artery bypass grafting (OPCAB). Methods A total of 342 patients scheduled for OPCAB between June 2013 and June 2015 were included in this study. According to results of preoperative duplex ultrasound examination of carotid arteries, patients were divided into CAS group (≥50%stenosis) and control group (<50%stenosis or no stenosis). The risk factors of CAS, death rate and the postoperative complications were compared between two groups. Results There were significant differences in age, smoking history, hypertension and chronic obstructive pulmonary disease (COPD) between two groups (P<0.05). Multivariate logistic regression analysis showed that advanced age (OR=1.050, 95%CI:1.014-1.086, P<0.01), hypertension (OR=2.566, 95%CI:1.299-5.071, P < 0.01) and COPD (OR=7.573, 95%CI:1.106-51.834, P < 0.05) were independent risk factors for CAS in OPCAB surgery. CAS (OR=4.530, 95%CI:1.361-15.078, P<0.05) and the history of percutaneous coronary intervention (OR=7.685, 95%CI:2.289-25.800, P<0.01) were independent risk factors for postop?erative death. Conclusion Risk factors for CAS in patients undergoing OPCAB include advanced age, hypertension and COPD. There is higher risk of death in CAS patients with OPCAB.