A 75-year-old man, who had undergone coronary artery bypass graft and repair for abdominal aortic aneurysm, suffered from angina pectoris due to severe aortic valve stenosis complicated with asymptomatic bilateral cervical internal carotid artery stenoses. Brain perfusion imaging revealed reduced cerebral blood flow and cerebrovascular reactivity to acetazolamide in the bilateral cerebral hemispheres. First, the patient underwent left carotid endarterectomy, and the postoperative course was uneventful. Postoperative brain perfusion imaging showed improvement of cerebrovascular reactivity to acetazolamide in the bilateral cerebral hemispheres. Seven weeks later, the patient underwent aortic valve replacement, and his postoperative course was uneventful. Carotid endarterectomy rather than carotid artery stenting should be preceded for cervical carotid stenosis complicated with severe aortic valve stenosis.