Respiratory obstruction has been reported as a complication of carotid endarterectomy; the causes include traumatic mucosal oedema, direct tracheal compression by haematoma and oedema secondary to lymphatic and venous congestion. We report four cases of acute respiratory obstruction complicating carotid endarterectomy. Two of these cases suffered respiratory arrest in the postoperative ward and required emergency tracheal intubation in difficult circumstances. All of these patients had developed wound haematomas and all required surgical intervention.