From an English language review and a review of the author's experience, the incidence of recurrent stenosis after carotid artery surgery is reported as varying from 0.5 to as high as 19%. Two types of lesions are identified: fibromuscular hyperplasia occurring after less than two years and secondary atherosclerosis beyond that period of time. The response to injury of the arterial wall is reviewed at the cellular level with speculations as to etiology of the lesions. Careful, thorough follow-up examination is strongly recommended.