Background: Atherosclerotic carotid artery disease is a major stroke cause, primarily treated via carotid endarterectomy (CEA) or carotid artery stenting (CAS). Evolving practices and patient profiles may influence intervention trends. This study reviews 10 years of carotid procedures at a tertiary centre to assess these changes. Methods: We retrospectively reviewed all carotid interventions for atherosclerotic disease at Northern Health from January 2015 to December 2024. Patients were identified via perioperative records and the Australasian Vascular Audit. Data on demographics, comorbidities, procedures, and perioperative outcomes were extracted and trends analysed with linear and logistic regression. Results: Over a 10-year period, 255 carotid procedures were performed, including 231 CEAs and 24 CAS. Mean patient age was 72.7 years, and 189 (74.1%) were male. Among CEAs, 56 eversion endarterectomies were performed, more commonly during the earlier years of the study, while 173 patch angioplasties were carried out. Majority of interventions (82.4%) were for symptomatic disease. In the symptomatic cohort, mean age rose from 71.1 years (2015) to 75.0 years (2024) (β = 0.54, p = 0.033).The proportion of symptomatic cases also increased over time (OR 1.15; 95% CI: 1.02–1.30; p = 0.018). No significant temporal trends were observed in patient comorbidities, hospital stay duration (p = 0.60), the proportion of symptomatic patients undergoing intervention during the index admission (p = 0.32), or perioperative stroke and mortality rates (p = 0.76). Conclusion: Over the study period, carotid interventions at Northern Health were increasingly performed on older and symptomatic patients. Despite this, key outcomes such as hospital stay, timing of intervention, and perioperative complications remained stable. These findings suggest a change in patient demographics and a more selective approach to treating asymptomatic carotid artery disease.