Objective To analyze the efficacy of carotid endarterectomy (CEA) in the very old patients with carotid stenosis. Methods The patients with arteriosclerotic carotid stenosis treated with CEA in our hospital from January 2010 to December 2015 were recruited in this study. They were divided into ≥70-year-old group and <70-year-old group. All the patients were followed up for at least 1 year. The efficacy, treatment safety, and incidence rates of restenosis and secondary stroke after the procedure were observed and compared between the 2 groups. SPSS statistics 19.0 was used to analyze the data. Student’s t test or Chi-square test (Fisher exact probability method) was used to make the comparison between groups for different data types. Results There were 722 patients enrolled in this study, including 279 patients being assigned into ≥70-year-old group and 443 patients into <70-year-old group. There were no significant differences in surgery-related death, 30-day ischemic stroke, or acute myocardial infarction between the 2 groups (P>0.05). ≥70-year-old group had obviously high ratio of hyperperfusion than <70-year-old group (6.8% vs 3.2%, P<0.05). After 1 year’s follow-up, no significant difference was seen in the incidence rates of carotid artery restenosis and secondary stroke between the 2 groups. Conclusion CEA is safe for the very old patients. However, the conditions of the elderly patients should be evaluated before operation in order to reduce the occurrence of post-operative complications.