Operative management of recurrent carotid restenosis following open and endovascular repair in the same carotid bifurcation

Surgical treatment of carotid stenosis consists of carotid endarterectomy (CEA) or carotid stenting (CAS). Restenosis after CEA/CAS is a challenging issue that surgeons encounter with increasing frequency. Here, we report a case where we employed several techniques for the treatment of carotid restenosis that were complicated by restenosis. Within 2 years, the patient underwent carotid endarterectomy, stent placement in the common-internal carotid, stent placement in the intracranial internal carotid artery, explantation of an extra cranial stent graft, a saphenous graft interposition and repositioning of the extra cranial carotid stent. A standard for the operative management of recurrent restenosis has not been established. Recurrent restenosis can be treated with different surgical techniques, but those techniques can be complicated by restenosis.