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.

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

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

Symptomatic mild carotid artery stenosis

• 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.

• Low risk of embolic events or stroke.
• Used to stratify cardiovascular risk and guide preventive therapy.

• Aggressive risk factor modification.
• No indication for surgical or endovascular intervention.
• Imaging surveillance to monitor progression.

• Usually asymptomatic
• No audible bruit in most cases
• Does not typically result in cerebral hypoperfusion

• Early atherosclerosis (most common)
• Post-radiation changes
• Non-atherosclerotic vasculopathies (less common)

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

• Lifestyle modification:
  • Smoking cessation
  • Mediterranean diet
  • Regular physical activity
• Medical therapy:
  • Antiplatelet agent (aspirin or clopidogrel)
  • Statin therapy
  • Blood pressure and glucose control

• Repeat ultrasound every 6–12 months to monitor progression
• Escalation of care if stenosis progresses or symptoms develop

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

• common carotid artery stenosis
• moderate common carotid artery stenosis
• internal carotid artery stenosis