Objective To investigate the management during offpump coronary artery bypass grafting (OPCAB) for patients with ascending aorta atherosclerosis and to find appropriate treatment for minimizing the postoperative cerebrovascular accidents. Methods 236 patients with ascending aorta atherosclerosis were retrospectively analyzed underwent OPCAB in this hospital from Sep.2004 to Dec.2007, 4 of them received “No-touch” technique, 35 of them had the proximal anastomoses with the Enclose assistant, and 197 of them had the proximal anastomoses with the assistant of Heartstring. Hemodynamic indexes were consecutively monitored, blood streams of grafts was monitored by transit time flow measurement (TTFM) to evaluate the quality. Results Distal anastomoses 881，proximal anastomoses 267, the blood stream of 881 grafts was monitored, the mean flow was 16.2±18.7 ml/min, and the pulsatility index (PI) were 4.9±2.3, indicating the good quality of all grafts. The change of hemodynamic indexes including mean artery pressure (MAP, 78.1±10.4 mmHg vs. 80.9±8.1 mmHg）, pulmonary capillary wedge pressure (PCWP, 11.9±3.6 vs. 10.9±2.1 mmHg）, mean pulmonary artery pressure (MPAP, 17.3±4.3 mmHg vs. 15.3±2.8 mmHg）, cardiac output (CO, 4.2±1.2 L/min vs. 4.5±1.6 L/min）, center vinous pressure (CVP, 9.2±2.3cmH2O vs. 9.3±1.8 cmH2O）, heart rate (HR, 71.4±14.0 beats/min vs. 73.4±16.5 beats/min）, there were no statistically difference between before and after proximal anastomoses (Pgt;0.05). Two patients died of low cardio output during operation, 4 patients with transient ischemic attack were improved by 2 months medical therapy, and others had no postoperative complications as perioperative myocardial infarction etc, and the time of stay hospital was 10.5±4.2d. Followup 3-24 months for 185 patients, all living patients had no myocardial or cerebrovascular accidents, the symptoms were alleviated and myocardiac function improved. Conclusion Assessing the degree of the ascending aorta atherosclerosis sufficiently before and during the operation, choosing different operational strategy, and decreasing the manipulation of aorta can decrease the incidence of cerebrovascular accident and get better clinical result.