Carotid artery restenosis can complicate all types of carotid revascularization, including carotid artery endarterectomy (CEA) and carotid artery stenting (CAS). Carotid artery in-stent restenosis (ISR) reported rates range anywhere from 2.7% to 33% (vs 5% to 22% for restenosis after CEA) [ ]. Early (<3 years) restenosis is driven by neointimal hyperplasia and vascular remodeling, whereas progression of carotid atherosclerosis is the main mediator for late restenosis (>3 years) [ ].