Domanin M, et al. - The potential of hemodynamic disturbances and geometric features to predict long-term carotid restenosis after carotid endarterectomy (CEA) was explored via assessing thirteen 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 performed hemodynamic and geometric characterization. They characterized geometry in terms of flare (the expansion at the bulb) and tortuosity. At 60 months after CEA, they applied Doppler ultrasound (DUS) for restenosis detection and intima-media thickness determination. As per Linear regressions, DUS observations of thickening with flare variables (up to R² = 0.84), were noted to be associated with the exposure to low (but not oscillatory) wall shear stress (WSS) (R² = 0.58). Findings suggest avoiding a large widening of the carotid bulb in arteriotomy repair, as it is linked to restenosis via the generation of flow disturbances. Hemodynamics and geometry-based analyses may assist in preoperative planning, guiding the PG vs PC clinical decision, and stratifying long-term restenosis risk after CEA.