Optimal Management of Carotid Artery Restenosis

Purpose of Review In the USA, carotid endarterectomy and stenting are the leading revascularization procedures for carotid stenosis with approximately 72,000–100,000 patients undergoing surgery each year for stroke risk reduction. Post-operatively, patients are surveilled annually to detect restenosis, and at 2-year follow-up, an estimated 2.0–6.0% of patients will develop recurrent disease. Recent Findings Restenosis is considered a maladaptive response of the artery to trauma, characterized by neointimal hyperplasia and vascular remodeling. Recent evidence supports a more conservative surveillance regimen in low-risk patients; however, management in high-risk patients is less well-defined. If detected, treatment strategies to address restenosis are similarly controversial. Summary In the following review, we discuss the pathophysiology of carotid restenosis, the indications and options for intervention, and current data regarding outcomes, as well as our preferred institutional approach.