OBJECTIVE: Assessment of operative morbidity and survival patterns after carotid endarterectomy. DESIGN: Retrospective clinical study. SETTING: University hospital, Norway. SUBJECTS: One hundred and ninety-four carotid endarterectomies done in 165 patients over a 16 year period. MAIN OUTCOME MEASURES: Long term survival was investigated using the product limit method. Expected survival of a demographically matched population was calculated from death-rate tables. Relative was defined as the ratio of the observed: expected survival. RESULTS: The combined stroke rate and mortality after 30 days was 5.1%. The estimated weight year survival rate of 73% did not differ from the expected. Relative survival seemed unaffected by the age at the time of the operation, hypertension or bilateral disease. Ischaemic heart disease was present in 69 patients (42%). This group had a mortality rate that was 2.4 times that expected during the first five years after operation. CONCLUSIONS: The overall long term survival of patients undergoing carotid endarterectomy seems to be similar to that of the general population. The patients with symptomatic ischaemic heart disease have a significantly lower long term survival than the expected.