This study states that As TCARs become more commonly performed, DU criteria need to be established to define 80% to 99% recurrent in-stent stenosis for those interventionalists (like me) who believe these findings warrant repeat endovascular intervention to prevent stroke or internal carotid artery occlusion. I have three questions regarding this study.

First, why should the criteria for restenosis after TCAR be any different from the criteria for carotid artery stents placed via a transfemoral approach (TF-CAS)? Previous studies have addressed recurrent stent stenosis after transfemoral carotid artery stenting. The only difference would likely be identifying focal dissections or stenosis where the sheath had been introduced in the CCA during TCAR. The authors agree with this sentiment.

Second, what criteria accurately define recurrent in-stent stenosis? I applaud the authors’ decision to follow the Society for Vascular Surgery guidelines reported by Zierler et al1 regarding recurrent in-stent stenosis. However, frankly, I am confused when other studies have suggested that a widely patent carotid stent will have higher baseline velocities.

Reference link-