Does Restenosis Still Hamper the Benefit of Carotid Artery Revascularization?

Both carotid endarterectomy (CEA) and carotid artery angioplasty with stenting (CAS) may offer acceptable short-term results in symptomatic or asymptomatic patients with carotid stenosis. Independent on the type of revascularization, the long-term benefit may be limited by recurrent stenosis, especially after endovascular treatment. Pathophysiological studies suggest that atherosclerotic plaque composition is an independent predictor of restenosis. Identification of certain plaque characteristics could help risk stratify patients in order to decide on the best therapy and minimize the risk of restenosis. Although currently no gold standard exists for the approach of recurrent carotid stenosis, both redo CEA and CAS seem safe therapeutic options. Limited data are available on treatment of recurrent carotid in-stent stenosis. More data are required in order to recommend the best therapy for in-stent restenosis.