Women and minorities were underrepresented in trials demonstrating carotid endarterectomy (CEA) is superior to medical treatment for significant carotid stenosis. These trials also revealed that the benefit of CEA is largely determined by the incidence of operative complications. Our series of 429 CEAs reflects a more diverse population (41% women, 24% blacks). We questioned if outcome was related to race, gender or other factors. Stroke occurred after 4.9 per cent of operations, cardiac events after 3 per cent, and death after 2 per cent. No factors correlated with cardiac events. Diabetes, smoking, neurologic symptoms, shunting, and patch closure did not correlate with complications. Chronic renal insufficiency (CRI), emergent operation, and operation by neurosurgeons correlated with stroke. Black females (BF) had significantly more strokes than did others (16% versus 3%). More BF had CRI, but their higher complication rate persisted when CRI patients were excluded. More BF were hypertensive (98% versus 74%), but hypertension did not correlate with complications. However, severe acute perioperative hypertension was common in BF experiencing complications and may be related to the differences observed. These findings highlight the need for better understanding of racial and gender outcome differences after CEA in order to improve risks and allow modification of selection criteria for high risk groups.