Carotid restenosis is not uncommon after both carotid endarterectomy (CEA) and carotid stenting (CAS). While neo-intimal hyperplasia leads to carotid artery restenosis within the first 2 years after treatment, later restenosis mostly results from progressive atherosclerosis. Patients with carotid restenosis may have a higher risk of stroke compared to those without restenosis. There are currently no guidelines that would stem from robust clinical studies. While patients with symptomatic carotid restenosis are usually actively treated using mostly endovascular techniques, such as stenting, the therapeutic algorithm is less clear in patients with an asymptomatic restenosis. Large randomized controlled trials are needed to help in guiding patients with restenosis after both CEA and CAS.