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<p><strong>Objective</strong> To review the clinical data of elderly patients treated by carotid endarterectomy (CEA) and carotid artery stenting (CAS), and analyze the safety of two kinds of surgery.  <strong>Methods</strong> A total of 691 patients with carotid artery stenosis underwent CEA (121 cases) and CAS (570 cases) respectively. The risk factors, clinical symptoms and postoperative complications in 2 groups of patients were analyzed, and the safety of two kinds of surgery were assessed.  <strong>Results</strong> After 30 d of operation, no significant difference was found between 2 groups in death rate (0.83% vs 1.05%, P = 1.000), stroke rate (4.13% vs 1.93% , P = 0.258) or myocardial infarction rate (0.83% vs 0, P = 0.175). Heart complications and cranial nerve injury rate in CEA group was significantly higher than that in CAS group (8.26% vs 1.05%, P = 0.000; 4.96% vs 0, P = 0.000), while sinus bradycardia or hypotension rate in CEA group was significantly lower than that in CAS group (0 vs 7.54%, P = 0.002). <strong>Conclusions</strong> Both CEA and CAS are safe for the elderly patients. However, the conditions of elderly patients should be evaluated before operation in order to reduce occurence of complications after operation. <br />doi：10.3969/j.issn.1672-6731.2014.01.006</p><p>Video: <a href="/index.php/cjcnn/pages/view/v14n1a6">http://www.cjcnn.org/index.php/cjcnn/pages/view/v14n1a6</a></p>