Transcarotid artery revascularization was performed in a 67-year-old woman for recurrent carotid stenosis 6 years following carotid endarterectomy for a high-grade asymptomatic carotid stenosis. Follow-up CTA showed approximately 50% carotid in-stent stenosis. Management options for carotid restenosis are discussed. The relationship of carotid restenosis to the development of ipsilateral stroke is described.