Mild Common Carotid Artery Stenosis [Neurosurgery Wiki]

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====== Mild Common Carotid Artery Stenosis ======

Mild stenosis of the common carotid artery (CCA) refers to a luminal narrowing of **less than 50%**, typically detected incidentally during vascular imaging. It is generally **asymptomatic** and rarely causes hemodynamic compromise.

===== Definition =====
  * **Luminal narrowing**: < 50%
  * **Duplex ultrasound**:
    * Peak systolic velocity (PSV) < 125 cm/s
    * No significant plaque or only minor irregularities

===== Classification: Mild Common Carotid Artery Stenosis =====

Mild common carotid artery stenosis is defined as **< 50% luminal narrowing**, typically without significant hemodynamic effect.

^ Classification Criteria ^ Mild Stenosis (^< 50%^) ^
| **Luminal Narrowing**            | < 50% diameter reduction |
| **Duplex Ultrasound**            | PSV < 125 cm/s, ICA/CCA ratio < 2.0 |
| **Hemodynamic Impact**           | None or minimal |
| **Symptoms**                     | Typically asymptomatic |
| **Plaque Characteristics**       | Minimal or early plaque, smooth or irregular |

[[Symptomatic mild common carotid artery stenosis]]
===== Imaging Correlation =====
  * **CTA/MRA**: Shows < 50% narrowing on cross-sectional images, usually no distal flow compromise.
  * **DSA** (if performed): Confirms non-critical narrowing; used rarely at this stage.

===== Clinical Implication =====
  * Low risk of embolic events or stroke.
  * Used to stratify cardiovascular risk and guide preventive therapy.

===== Management Focus =====
  * Aggressive risk factor modification.
  * No indication for surgical or endovascular intervention.
  * Imaging surveillance to monitor progression.


===== Clinical Features =====
  * Usually asymptomatic
  * No audible bruit in most cases
  * Does not typically result in cerebral hypoperfusion

===== Etiology =====
  * Early atherosclerosis (most common)
  * Post-radiation changes
  * Non-atherosclerotic vasculopathies (less common)

===== Diagnosis =====
  * **Carotid Duplex Ultrasound** – main modality
  * May be noted on CTA or MRA done for other reasons

===== Management =====

==== Conservative (Standard of Care) ====
  * **Lifestyle modification**:
    * Smoking cessation
    * Mediterranean diet
    * Regular physical activity
  * **Medical therapy**:
    * Antiplatelet agent (aspirin or clopidogrel)
    * Statin therapy
    * Blood pressure and glucose control

==== Follow-up ====
  * **Repeat ultrasound** every 6–12 months to monitor progression
  * Escalation of care if stenosis progresses or symptoms develop

===== Prognosis =====
  * Excellent with optimized risk factor control
  * Low annual stroke risk (< 1%)
  * Risk of progression to moderate/severe stenosis exists in poorly controlled patients

===== See Also =====
  * [[common carotid artery stenosis]]
  * [[moderate common carotid artery stenosis]]
  * [[internal carotid artery stenosis]]