Aim. The study looks at clinical and instrumental factors associated with adverse outcomes in the hospital and long-term follow-up when using various surgical strategies for treatment of patients with multifocal atherosclerosis.Methods. From 2011 to 2015, three hundred ninety-one patients with combined hemodynamically significant atherosclerotic lesion of the coronary bed and internal carotid arteries were included in this study in a continuous sampling mode. A detailed analysis of the prognostic significance of a wide range of clinical-instrumental, anatomical-angiographic and perioperative factors was performed.Results. Against the background of patients’ initially severe comorbid condition, the most significant hospital risk factors were III–IV functional class angina and stroke in the anamnesis. It is important to note a high risk of complications, with bleeding reaching three points or higher on the Bleeding Academic Research Consortium (BARC) scale during simultaneous coronary artery bypass graft surgery and carotid endarterectomy. At the same time, EuroSCORE II value not higher than 2% and the duration of artificial circulation 74 minutes or less turned out to be protective factors. Conclusion. The study is not randomized and requires further research on the algorithms for choosing the optimal option of revascularization in this group of patients. The results obtained can form the basis for further research aimed at developing optimal surgical protocols for patients with multifocal atherosclerosis.Received 2 August 2017. Revised 16 October 2017. Accepted 25 October 2017.Funding: The research was done with support of the grant (No. 12090ГУ/2017) awarded by the Fund for Facilitation of Innovations within the framework of the “Umnik-2016” project (Kemerovo).Conflict of interest: Authors declare no conflict of interest.Author contributionsConception and study design: R.S. TarasovData collection and analysis: A.A. Golovin, N.N. Burkov, M.G. ZinetsDrafting the article: A.N. KazantsevCritical revision of the article: S.V. Ivanov, A.I. AnoufrievFinal approval of the version to be published: R.S. Tarasov, A.N. Kazantsev, S.V. Ivanov, A.A. Golovin, N.N. Burkov, A.I. Anoufriev, M.G. Zinets, L.S. Barbarash