The early complications of carotid endarterectomy are attributed to clamping ischemia, intraoperative embolization, and thrombosis of the newly endarterectomized carotid artery. An unusual mechanism is due to intracranial hemorrhage. The differential diagnosis can usually be established by a combination of oculoplethysmography, CT scanning of the brain, exploration of thrombosed carotid arteries, and repeat angiographic studies. Other complications, including acute myocardial infarction, wound hemorrhage, and infection, are discussed.