SUMMARYThe total neurological complication rate in 783 consecutive carotid angiograms was 2.3% (2.7 % per patient). The permanent complication rate, including death, was 1.5% (1–8% per patient).With one exception, the patients in the permanent neurological complication group were over the age of 50.Of the patients experiencing neurological complications, 55.5% had received an intramural injection of contrast medium into the common carotid artery.The use of polaroid film to check the position of the needle is advocated to minimize intramural injection of contrast medium.Toxic side effects of the contrast medium was a less common cause for complications, but was considered potentially harmful in those patients with occlusive cerebro‐vascular disease.General anaesthesia should be kept to a minimum, particularly in patients with subarachnoid haemorrhage, as the complication rate is two to three times higher than when angiography is carried out under local anaesthetic.