Background: To evaluate the outcome of carotid endarterectomy (CEA) in octogenarians. Method: Between January 2005 and July 2010, all CEA patients were prospectively recorded. Patients were categorized into those <80 and ≥80 years of age. Primary outcome measures were hospital duration of stay (HDOS), mortality, any stroke, and postprocedural complications. Results: In total, 477 patients with carotid artery stenosis were treated with CEA. Seventy-one patients (13%) were ≥80 years of age and 477 (87%) patients were <80 years of age. Median HDOS was 3.0 days (interquartile range [IQR], 2-5) for the entire cohort with a median of 3 days (IQR, 2-4) for patients <80 years of age and 4 days (IQR, 2-7) for patients ≥80 years of age (P = 0.0001). Fifteen patients (3%) had an early adverse neurologic event, with 7 patients (1.3%) developing a transient ischemic attack, 2 patients (0.3%) a minor stroke with full neurologic recovery, and 6 patients (1.1%) had a major stroke. Forty patients (6.8%) had a postoperative nerve injury. No statistical differences were observed between the younger (<80 years of age) and older (≥80 years of age) group despite a significant difference in postoperative delirium (P < 0.0001). During follow-up, more fatal cardiac events occurred in the octogenarians group (4.2% vs. 0.4%; P = 0.02). Kaplan-Meier analysis revealed a significantly better survival for the younger patients (log rank test; P = 0.04). Conclusions: Octogenarians who suffer from carotid artery stenosis can be safely treated by CEA. The increased incidence of postoperative delirium is an important finding and requires extra attention in this vulnerable group.