Upper airway obstruction after carotid endarterectomy is a rare but potentially fatal complication of carotid endarterectomy. Upper airway obstruction is also a well recognized complication after neck surgery involving the thyroid gland and cervical spine. The airway obstruction usually develops slowly over a few hours and the onset is unpredictable. We report a patient who developed upper airway obstruction 16 hours following carotid endarterectomy. She required re-intubation in the intensive care unit (ICU). Fibreoptic assessment demonstrated severe supraglottic and glottic oedema. Tracheostomy was performed on day 2 postoperatively. Serial fibreoptic assessment of the upper airway showed gradual resolution of glottic edema and decanulation was successful on day 43.