Aim. To analyze early and long-term results of surgical treatment of combined coronary and carotid atherosclerotic lesion using different approaches. Material and methods. The study included 172 patients with concomitant coronary and carotid lesion who underwent simultaneous, staged and hybrid reconstructive surgery. All patients were operated in the Department of Cardiac Surgery I of Petrovsky Russian Research Center of Surgery for the period from January 2005 to November 2015. Patients were divided into 3 groups depending on surgical tactics. Preoperative data were comparable in both groups. Results. It was shown that simultaneous coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA) don't increase incidence of acute cerebrovascular accident and myocardial infarction compared with staged and hybrid approaches. Incidence of intra- and early postoperative complications, mean ICU-stay (16.2—21.4 hours), hospital-stay (8.4±3.6 days), time of surgery (254±24 min), cardiopulmonary bypass (58±15 min), aortic cross-clamping (36±10 min), ICA cross-clamping (12±4.1 min) were comparable with those in patients after staged surgery. Long-term survival for simultaneous and staged treatment was also similar (A — 97%; В — 76%; С — 86% (p=0.858)). However in long-term period the incidence of stroke was significantly higher in group of staged surgery after myocardial revascularization (А−В+С (р=0.021)). So, the second surgical stage should be performed as soon as it is possible in these patients. Conclusion. Our data report that intraoperative risk of simultaneous treatment of coronary and carotid lesion is overestimated in the literature. One-stage surgery is effective strategy in patients with coronary artery disease and carotid lesion. Moreover, this method prevents possible cerebrovascular complications in postoperative period.