Cerebral stroke can occur in patients having visual symptoms only. Fundoscopy is valuable in identifying those patients with visual symptoms who are likely to have carotid disease; and carotid endarterectomy can prevent a stroke in a significant percentage of patients at risk. Meticulous operative technique is essential. In a series of 187 carotid endarterectomies performed on 154 patients over a 7-year period, the operative mortality rate was zero. Operative morbidity was 1.3% in 139 patients who had no prior permanent neurological deficits, and 13% in 15 patients who had suffered previous strokes. Data compiled on follow-up for an average of 20 months indicated that six patients (4.7%) suffered postoperative strokes, nine patients (7%) experienced persistence of symptoms, and 113 patients (88.3%) remained neurologically well.