Introduction. The efficacy and safety of surgical treatment of brachiocephalic arteries atherosclerosis in advance age patients becomes the most topical at present time. Material and methods. The study included 813 patients older than 70 years who underwent brain revascularization. The first group included 392 patients after carotid endarterectomy (CEA), the second group — 421 patients who underwent carotid artery stenting (CAS). Both groups were similar in the initial severity of disease and comorbidities. Results. In patients older than 70 years the incidence of stroke after CEA was significantly lower than in CAS group (p=0.04). Incidence of perioperative myocardial infarction is 3 times higher in case of CEA (p=0.03). Conclusion. The minimal number of stroke in patients older than 70 years is observed in case of CEA. However this method has the risk of perioperative myocardial infarction development. CAS may be preferred for non-embologenic atherosclerotic plaques in patients with severe cardiac pathology.