Cerebral arteriograms in 1141 patients, as direct percutaneous carotid or brachial studies or as transfemoro-cerebral catheter studies, were reviewed. The overall complication rate for the direct percutaneous studies was higher; the incidence of both transient and permanent neurologic complications was higher in the transfemoral group. This may be related to the frequent irrigation of the catheter, which increases the probability of embolism. The incidence of serious complications was lower than in previous studies perhaps because gravely ill patients are more likely to undergo computed tomographic scanning.