OBJECTIVE: The use of cerebral angiography (ANGIO) to select patients for carotid endarterectomy (CEA) has been limited by concern about the risk of complications of the procedure. The authors sought to determine the rate of neurologic complications at both an academic medical center (AMC) and a community hospital (CH). METHODS: The authors reviewed the records of 569 patients undergoing ANGIO. Any documentation of stroke, transient neurologic event, myocardial infarction, or death occurring in the 24 hours after the procedure was recorded. The rate of neurologic complications at the AMC and CH were compared to published studies. RESULTS: The overall complication rate was 0.5% for stroke and 0.4% for TIA. There was no difference between the AMC and CH. One of the strokes was of moderate severity and four of the five patients with complications subsequently underwent endarterectomy. CONCLUSIONS: The rate of major neurologic complications due to ANGIO may be lower than expected, even when performed in a non-academic setting. Awareness of local ANGIO complication rates is important when selecting patients for CEA.