Introduction: Carotid endarterectomy (CEA) is the accepted treatment for stroke risk reduction in patients with symptomatic 50–99% carotid artery stenosis. Best practice guidelines recommend surgery be performed within 14 days of index symptoms to achieve maximum benefit; however, achieving this target can be difficult. Late presentation and presentation to hospitals without onsite vascular capabilities are two recurring reasons for delayed CEA across the literature. Methods: All symptomatic CEAs performed between January 2017 and December 2019 were retrospectively extracted from an electronic institutional database and analysed to determine the proportion of CEAs meeting benchmark targets and to assess factors contributing to delays. Results: A total of 124 CEAs were performed for 62 strokes and 62 transient ischaemic attacks (TIAs); 71.8% (n=89) were male and the median (range) age was 71.0 years (43–88). The median delay between initial symptom and CEA was 14 days (range 1–183). Sixty-six patients (55%) had surgery within 14 days of the index symptom. Patients presenting with ‘Face Arms Speech Time’ (FAST) symptoms were significantly more likely to undergo timely CEA, largely due to earlier presentation to hospital (p=0.021, OR 2.563, 95% CI 1.143 to 5.747). Presentation directly to a tertiary vascular centre was significantly associated with CEA within 14 days compared with referrals from external hospitals (p=0.002), with a median symptom-to-surgery interval of 12.0 days and 25.0 days, respectively (p=0.001) Conclusions: Our results are comparable to UK and Australian national audits, although a significant number of CEAs fell outside the 14-day target. Protected pathways between referring hospitals and vascular centres are needed to ensure all patients have equal access to urgent CEA. Designating CEA within 14 days as a key performance indicator for stroke management will hopefully incentivise hospitals to expedite this high-risk cohort. Furthermore, re-auditing with an emphasis on patients turned down for intervention due to recurrent events while awaiting CEA may further highlight the need to prioritise symptomatic carotids.