Objective Carotid endarterectomy (CEA) has been demonstrated to reduce risk of recurrent stroke in symptomatic patients with a 50-99% carotid artery stenosis. Performing CEA within 2 weeks of symptom onset results in the greatest risk reduction and has been recommended by international guidelines. The purpose of this study was to evaluate the timeliness of CEA performed in an Australian tertiary vascular surgery centre and to identify the impact of rurality on this outcome. Methods We performed a retrospective single-centre observational study at the Princess Alexandra Hospital, Queensland, Australia. Patients who received CEA for symptomatic carotid stenosis between October 2017 and October 2022 were included. The primary outcome measure was delay to CEA beyond 2 weeks of symptom onset. We used a logistic regression model to analyse the association between the primary outcome and rurality, as well as other clinical features. Results 230 patients (30% female) were included. Delay to CEA was greater than 2 weeks in 50% of patients. Patients from rural or remote communities, those with high-grade (80-99%) carotid artery stenosis, and those who presented with stroke were more likely to receive CEA within 2 weeks of symptoms. Age, gender, comorbidities, smoking status, and socioeconomic status were not associated with delay to CEA. Conclusion Only half of the symptomatic carotid artery stenosis patients received CEA within the recommended 2-week timeframe. Patients who presented with stroke or high-grade carotid stenosis were more likely to receive timely CEA. Contrary to our expectations, rural or remote residents were more likely to receive CEA within 2 weeks compared to their metropolitan counterparts. “Rural reversal” may be present in our cohort and future studies should examine the generalisability of our findings.