Carotid endarterectomy is a surgical procedure in which an atherosclerotic plaque is removed from the carotid artery to avoid future stroke. A small proportion of patients will have adverse effects from surgery and need emergency blood-pressure management to avoid intracranial haemorrhage. This paradoxical risk of operation-related stroke leads to continuing controversy about this procedure. Large randomised trials have shown good evidence of benefit in symptomatic patients. However, despite the benefits of swift treatment, patients in the UK are still likely to have significant delay to treatment.