Combined carotid endarterectomy (CEA) and coronary artery bypass graft (CABG) has been traditionally advocated for patients in whom symptomatic disease has been elicited in both vascular territories. This rationale has related to the concern for an increased myocardial infarction rate following CEA with untreated coronary artery disease and conversely, the potential for stroke in patients receiving CABG with untreated carotid stenosis. Although significant cardiac and cerebral complication rates have been identified in these combined cases, justification for the procedure has stemmed from combined rates obtained which were lower than those encountered for either procedure performed in isolation. There has been a trend toward performance of combined CEA/CABG in patients with asymptomatic carotid stenosis. Release of the Asymptomatic Carotid Atherosclerosis Study (ACAS) in 1995 appears to have played a significant role in changing trend. Interpreting the ACAS data finding is problematic for the combined procedure. Yet controversy continues concerning the most appropriate management for patients with severe coronary artery disease who also have asymptomatic carotid stenosis. Recently we have successfully managed two cases of coronary artery disease and asymptomatic carotid stenosis patients by combined CEA and CABG without any surgical complication. We report these 2 cases and briefly review the literature.