The main purpose of carotid endarterectomy (CEA) and carotid stenting (CAS) is stroke prevention. the conclusions regarding the efficacy and safety of CEA as stroke prevention in patients with symptomatic and asymptomatic significant carotid stenosis and its advantages over optimal drug therapy are positive. However, recent years have been an era of rapid development of endovascular therapy for vascular diseases, and with the introduction and development of CAS, the number of CEAs has declined. Although the topic of CEA has been the subject of much technical and clinical debate over the years, such as general or cervical plexus block anesthesia, conventional or selective shunts, the value of complete duplex and angiography in ruling out defects in the repair technique, the most appropriate patch material, and many other clinical issues, these debates None of these debates is as active and passionate as the debate over the appropriate indication for CAS or CEA. The crux of the debate now is which treatment is best for the patient based on objective evidence. The challenge for clinicians in stroke prevention in patients with carotid artery disease is to identify which of these two treatments is most appropriate for the individual patient. In the early years of CAS, it was logical to assume that this technique, called minimally invasive, would be most appropriate for older patients, who were considered to be a high-risk group (simply based on age), because of severe comorbidities and an increased risk of perioperative complications after conventional CEA. However, numerous early studies and trials have confirmed that advanced age is actually a specific risk factor for perioperative stroke after CAS. In addition, studies from Johns Hopkins Hospital and other hospitals have shown that advanced age is actually a specific risk factor for perioperative stroke after CAS. Hopkins and other hospitals have clearly confirmed that CEA can be performed in older patients with outcomes comparable to those of younger patients. In a review of 44 published publications (including 512685 CEA and 75201 CAS procedures), CEA was found to be a better option for clinical outcomes in the elderly patient population with significant carotid lesions, although the meta-analysis had some limitations. The value of any meta-analysis is limited by the quality and limitations of the studies analyzed, and this meta-analysis is no exception. The definition of old age varies between case series studies (from 80+, 75+, 70+, or even 65+ years of age have been reported). It is clear that there is no consensus in the literature about the true definition of old age. For example, the recently completed Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) found that CEA was significantly superior to CAS in patients over 69 years of age. In CREST, perioperative stroke and mortality were higher for CAS than for CEA in both symptomatic and asymptomatic patients, but this difference was statistically significant only for symptomatic patients Older adults are the most rapidly growing segment of today’s population. CAS is an evolving technology and its effectiveness will continue to improve, as evidenced by findings in the literature with publication dates that have an impact on it. With further improvements in cerebral vascular protection methods and stenting techniques, as well as better selection of patients for surgery, we can expect further improvements in CAS regression in the future. CAS is an important tool for selected patients with significant carotid lesions and remains an important member of the therapeutic “armamentarium”. However, based on the large body of evidence available to date (as shown in the meta-analysis by Antonius et al. and the recent CREST study), CEA appears to be the most appropriate procedure for the majority of elderly patients with significant carotid lesions who are at risk for stroke.