Domanin M, et al. - Researchers investigated if hemodynamic disturbances and geometric features can predict long-term carotid restenosis after carotid endarterectomy (CEA). They performed 13 CEA for carotid diameter stenosis > 70% with patch graft (PG) angioplasty in nine cases, and primary closure (PC) in four cases. Using MRI acquisitions within one month after CEA, they characterized hemodynamic disturbances and geometric features. The exposure to low and oscillatory wall shear stress (WSS) was determined using personalized computational hemodynamic simulations. Characterization of geometry was done in terms of flare (the expansion at the bulb) and tortuosity. Doppler ultrasound (DUS) was applied at 60 months after CEA for restenosis detection and intima-media thickness determination. DUS observations of thickening were noted to be associated with flare variables, and the exposure to low (but not oscillatory) WSS. As per findings, they suggest avoiding a large widening of the carotid bulb while performing arteriotomy repair, which is linked to restenosis via the generation of flow disturbances. Outcomes support the potential utility of hemodynamics and geometry-based analyses for preoperative planning, guiding the PG vs PC clinical decision, and for stratifying long-term restenosis risk after CEA.