Atherosclerosis is a systemic disease, and as the disease progresses, the lesions often involve large and medium-sized muscular arteries. The heart and brain, as the most important organs for human survival, will be seriously affected once their blood supply arteries, i.e. coronary arteries, carotid arteries and intracranial arteries, are involved. For atherosclerotic diseases of a single organ, the treatment strategy is relatively easy to make, but when two organs are involved at the same time, the treatment decision is often troubling and often faces a dilemma. In the case of coronary artery and carotid artery, which are common sites of atherosclerosis, when the local artery stenosis is severe or even when multiple arteries are involved (e.g., multiple coronary artery lesions), i.e., when both coronary and carotid arteries need to be treated, how do you choose? Who should be treated first? Who comes second? How to reduce the risk? Is there a way to kill two birds with one stone? As arterial stenosis or occlusive disease, treatment usually includes endoluminal therapy (mainly stenting) and open surgery. When both carotid and coronary artery disease is present in a patient, various combinations of treatment decisions can occur. Here, we will first discuss one of these combinations, i.e., open surgery to treat both diseases: carotid endarterectomy + coronary artery bypass grafting. How do you make decisions about the timing of treatment for both procedures? When two vital organs, the heart and the brain, are on the decision scale at the same time, it often puts one in a dilemma. If coronary artery bypass is performed first, there will inevitably be circulatory instability, i.e., large fluctuations in blood pressure, during the procedure. In the case of hypotension, severe carotid stenosis can easily lead to cerebral infarction due to reduced cerebral perfusion, which can have a serious impact on the quality of life and even endanger life. If carotid endarterectomy is performed first, the instability of the heart condition makes it difficult to maintain the blood pressure stability during general anesthesia; moreover, during carotid artery block, in order to ensure cerebral perfusion, an induced boost is often performed to reduce the impact of arterial block on cerebral perfusion, which is a huge burden on the heart. It can be said that intraoperatively, and postoperatively, there is a threat of heart failure. Simply put, treating any one lesion separately in separate sessions, regardless of the sequence, exposes one to the risk of general anesthesia twice and also to the risk of severe impairment of vital organ function twice. So, how can the risk be minimized? Is there a way to kill two birds with one stone? Numerous clinical studies have shown that staged surgery in patients with combined severe coronary and carotid artery disease can increase mutual cardiovascular and cerebrovascular complications in the perioperative period. The advantage of performing carotid endarterectomy and coronary artery bypass surgery at the same time is that the reconstruction of coronary and carotid blood flow is performed simultaneously under the same anesthesia, which reduces the strike of secondary surgery and secondary anesthesia, decreases the incidence of perioperative cardiovascular and cerebrovascular complications and mortality, reduces the chance of myocardial infarction or stroke between the two surgeries, and greatly reduces the number of hospital days and costs. For such high-risk patients, strict grasp of surgical indications, perfect preoperative evaluation, precise surgical operation and strict perioperative management will help reduce perioperative complications and mortality. After successful general anesthesia, carotid endarterectomy and saphenous vein removal necessary for coronary artery bypass grafting can be performed simultaneously, reducing the overall operative time. In a recently completed case, the combined simultaneous procedure added only about one hour to the operating time compared to a typical coronary artery bypass surgery, in exchange for a rapid improvement in the function of two vital organs and a rapid postoperative recovery.