Background: The optimal management for patients with concomitant severe coronary artery disease (CAD) and carotid artery stenosis (CAS) remains controversial. We reported our preliminary experience on a synchronous hybrid strategy. Methods: Seven patients with synchronous percutaneous coronary intervention (PCI)/carotid endarterectomy (CEA)/coronary artery bypass grafting (CABG) and 36 patients with synchronous CEA/CABG were enrolled. Then we analyzed the demographics, risk factors and 30-day results of the 2 groups, retrospectively. Results: The 2 groups were comparable in demographics. The operation time was 312.14 +/- 40.08 minutes for synchronous PCI/ CEA/CABG and 294.58 +/- 47.62 minutes for synchronous CEA/CABG (P = 0.367). The intraoperative blood loss was 814.29 +/- 195.18 mL for synchronous PCI/CEA/CABG and 769.44 +/- 330.21 mL for synchronous CEA/CABG (P = 0.731). There was no death in the 2 groups within 30 days. The incidence of primary endpoint [stroke, myocardial infarction (MI) and death] was 14.29% (1/7) in synchronous PCI/CEA/CABG group and 5.56% (2/36) in synchronous CEA/CABG group. The difference between the 2 groups was not statistically significant (P = 0.421). Conclusion: Synchronous PCI, CEA and CABG may be safe and effective in the management of patients with concomitant CAS and complicated multi-vessel CAD. The current data suggested that more studies and randomized controlled trials may be necessary to define whether this strategy is suitable for these patients.