Background: There have been some controversies to the current ACC/AHA guidelines in which carotid endarterectomy (CEA) is probably recommended before or concomitant to coronary artery bypass grafting (CABG) in patients with significant carotid artery stenosis. Carotid artery stenting (CAS) has been recently challenged to take place of CEA in high risk patients. The objective of this study was to assess the clinical outcomes of patients undergoing staged CAS followed by elective CABG. Methods: Between Apr, 2002 and Oct, 2007, a total of 42 patients (44 lesions) with coexisting carotid and coronary atherosclerotic disease underwent CAS followed by CABG. We analyzed clinical outcomes during in-hospital period for carotid stenting, between discharge and the CABG, 30 days after the CABG, follow-up after 30 days. Stroke and all-cause mortality rates were assessed at different time. Results: The mean age was 67 years (male, 84%). 36% were bilateral carotid stenosis (���50% stenosis) and all lesions had severe stenotic lesion (41 lesions; 70%-90% stenosis and 3 lesions; ���90% stenosis). Asymptomatic carotid artery stenosis was present in 79% of lesions. The mean time from CAS to CABG was 65.4짹24.6 days. Stents were successfully placed in all lesions. Embolic protection devices were used in 89% of lesions. Only one stroke (1/44, 2.3%) was developed (acute posterior inferior cerebral artery infarction) during CAS. There were no peri-operative bleeding or neurological complications associated with CABG. The overall combined 30-day event rate after CABG including all event during or after CAS, were 2.3%. During mean follow-up of 27.8짹15.8 months, there were no late death and additional stroke. Conclusion: Although our study is a single center and small cohort, our results may suggest that the CAS before CABG is safe and effective strategy to prevent stroke associated with CABG.