Trends in utilization of carotid endarterectomy (CEA) among elderly ethnic minorities have received little attention. Data from the U.S. Centers for Medicare and Medicaid Services were examined for the years 1990 through 2000. In women and men, the rate of CEA per 100,000 non-HMO beneficiaries aged ≥65 years increased in African Americans and in European Americans between 1990 and 1995, with only small changes thereafter. Between 1990 and 2000, the ratio of rates in European Americans to those in African Americans have decreased slightly, i.e., in women from 2.63 in 1990 to 2.24 (15%) in 2000 and in men from 3.94 to 3.39 (14%). Large ethnic differences in utilization of CEA persist in the elderly requiring further evaluation.