Patients with atherosclerotic carotid disease have a high incidence of concomitant coronary artery disease. This chapter presents a case study of a 59-year-old male presented for a right carotid endarterectomy (CEA) under regional anesthesia. A cardiac catheterization was followed by percutaneous coronary intervention with two bare metal stents to the left anterior descending and obtuse marginal vessels. The patient was instructed to hold his clopidogrel 5 days prior to his scheduled carotid surgery and to continue his aspirin perioperatively. After a stable intraoperative course, the patient was transferred to the recovery room in a stable condition. Patients with S-T segment elevation myocardial infarction (STEMI) of sufficient size have a reduction in left ventricle (LV) function resulting in a reduced stroke volume, reduced systemic blood pressure, and a consequent reduction in coronary perfusion pressure. Surgical patients with postoperative STEMI are poor candidates for fibrinolytic therapy.