Acute hemodymanic instability after CEA is a well – recognized phenomenon. Both hypotension and hypertension can occur and may result in prolonged hospital admission or more seriously, may be associated with neurological complications. In almost all cases hypo/ hypertension is transient and rarely persist beyond 24 hrs. Herein we report an unusual case of unexplained, refractory prolonged hypotension after carotid endarterectomy.