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Epidemiological studies indicate that the risk of first ever stroke is strongly related to age. Based on the NASCET and ECST results, carotid endarterectomy (CEA) is a well-established indication for the prevention of ischemic stroke in patients with 70-99% symptomatic internal carotid artery (ICA) stenosis and in selective cases with moderate stenosis (50-69%). A recent analysis of data from the NASCET group, clearly demonstrates that elderly patients (age75 years) with symptomatic ICA stenosis benefit more from CEA compared to younger patients. However, the NASCET collaborators point out that the greater benefits achieved in patients older than 75 years compared to other age groups in the trial depends on the fact that CEA was performed on the elderly having a higher risk of ipsilateral ischemic stroke if treated medically and the lowest surgical risk. In order to obtain the treatment benefit reported, operation performed by skilled surgeons and meticulous medical screening of the elderly patients is recommended to exclude life-threatening conditions.