Between 1 January 1990 and 1 September 1994 a total of 109 carotid endarterectomies were performed without preoperative angiography. Only two cases were considered by the surgeon to have a poor correlation between the duplex examination results and intraoperative findings; the outcome was good in both. The perioperative mortality rate was 1.8 per cent, one patient dying from sudden haematoma causing asphyxia and the other from unrelated causes following a myocardial revascularization procedure. Two non-disabling strokes also occurred. These results suggest that carotid endarterectomy based on carotid duplex scanning alone without preoperative angiography is safe in selected patients.