Background: Hypotension during off pump coronary artery bypass graft (CABG) surgery is commonly due to positioning of the heart or due to intraoperative ischemia, but sometimes, it is deliberate and controlled during aortic clamping. Due to hypotension, the risk of cerebral hypoperfusion or stroke is high during CABG surgery in patients with bilateral carotid artery stenosis. Methods: Various cerebral monitoring techniques are recommended to detect cerebral hypoperfusion during CABG. Results: Entropy is used for the assessment of depth of anesthesia. In our patient for CABG with associated bilateral carotid artery disease, entropy helped in timely detection of cerebral hypoperfusion. Conclusion: The best management approach of carotid artery disease associated with coronary artery disease still remains debatable.