Objective To investigate the effect of on-pump and off-pump procedures on postoperative cerebral complications and survival rate after coronary artery bypass grafting (CABG). Methods From June 2003 to June 2013, a total of 159 patients [(67.0±7.5) years old, 118 males and 41 females] with carotid arteriostenosis and coronary heart diseases, accepted isolated CABG in our department. They were divided into on-pump group (n＝95) and off-pump group (n＝64). The prevalence of postoperative cerebral complications and the survival rate after CABG were compared and retrospectively analyzed. Results Follow-up was done for 146 patients with a rate of 93.6%, and a duration of (46.3±25.3) months, ranging from 6 to 120 months. Ten patients had neurological symptoms, including 2 of cerebral hemorrhage and 8 of stroke. Seventeen patients died during the follow-up (4 due to cerebral complications, 1 esophagus cancer, 1 lung cancer, and 11 cardiogenic reasons) within average 41 months postoperatively (ranging from 4 to 72 months). There was no statistical difference in prevalence of postoperative cerebral complications and the survival rate between on-pump and off-pump groups (P＞0.05). Conclusion On-pump and off-pump procedures have no significant difference in the effect on postoperative cerebral complications and survival rate in the patients with carotid arteriostenosis and coronary heart diseases.