Recurrent carotid disease occurs in 4–10% of patients following carotid endarterectomy. This chapter describes in-depth pathogenesis and types of carotid restenosis. Diagnosis of the disease and indications for the surgical interventions as well as types of interventions are discussed. The emphasis is on surgical management of recurrent carotid disease. Due to the authors’ extensive experience in re-operative management of the carotid disease, the intricacies and step-by-step surgical approach are described, including pitfalls and complications.