AimsCarotid artery stenosis increases the risk of ischemic stroke, with carotid endarterectomy (CEA) and carotid artery stenting (CAS) as primary interventions. Age-related vascular changes may contribute to complications. This study aimed to evaluate the impact of age-related vascular changes on postoperative complications and procedural outcomes. MethodsA retrospective cohort of 470 patients who underwent CAS or CEA from January 2020 to November 2021 was analyzed. Demographics, anatomical characteristics, and postoperative complications were assessed. Correlation, regression analyses, and machine learning models were applied to identify predictors of adverse outcomes. ResultsPostoperative complications occurred in 64.9% of CAS and 75.2% of CEA patients. Older age correlated with larger CCA diameter, shorter clavicle-to-bifurcation distance, and increased tortuosity of both CCA and ICA. Several age-related anatomical changes were significantly linked to higher complication rates in both procedures. In CAS, key predictors included symptomatic stenosis, aortic arch variation, CCA ostial lesions, and CCA diameter (p < 0.05). A logistic regression model predicted CAS complications effectively (AUC = 0.82). ConclusionThis study highlights significant age-related changes in carotid artery anatomy and their impact on postoperative complications. These findings underscore the importance of considering age-related vascular remodeling to enhance patient selection and optimize surgical outcomes.