Of 456 consecutive carotid endarterectomies performed at the University of California, San Diego, 127 were in patients who had sustained a previous completed stroke and had recovered with minimal but permanent neurologic deficits (PNDs). Operative mortality for the entire series was 0.9%, but it was 3.1% for the stroke group. A postoperative PND was observed in 2.1% of patients without neurologic deficits but occurred in 3.9% of the patients after stroke. A 97% one-to-ten-year follow-up was obtained. The total early and late serious morbidity and mortality in this surgically treated series of patients after stroke was 24% at five years. We conclude that carotid endarterectomy for the prevention of recurrent stroke carries a high risk and may not be superior to nonoperative treatment.