Larry B. Goldstein, MD
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This article was published online first at www.annals.org on 8 July 2014.
Goldstein LB. Screening for Asymptomatic Carotid Artery Stenosis: Caveat Emptor. Ann Intern Med. 2014;161:370-371. doi: 10.7326/M14-1332
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Published: Ann Intern Med. 2014;161(5):370-371.
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Earl W. Ferguson, MD, PhD, FACC, FACP, FACPM
Ridgecrest Regional Hospital
July 7, 2014
What's wrong with carotid auscultation as the preferred diagnostic tool?
I check the carotid pulse and listen for carotid bruits on every patient and have found many significant carotid stenoses the were asymptomatic and required intervention. I concur with the recommendations in this Annals issue. Have we forgotten that the best way we can do a cost-effective and efficient screening for carotid stenoses is with a good physical exam that always includes auscultation of the carotids?
David L Keller, MD
July 8, 2014
You cannot concur and still perform the exam they advise against
First, I concur with you, Dr. Ferguson when you advocate listening for carotid bruits in asymptomatic patients to screen for carotid stenosis.However, I would point out that you are thereby acting in direct opposition to the advice by the USPSTF not to screen asymptomatic patients, which means you do not "concur" with them.You and I need to admit to ourselves that we disagree with the 16 primary care physicians on the USPSTF. They are using obsolete data from studies which did not employ high-dose statins as a treatment option for the systemic condition known as atherosclerosis.
Neurology, Stroke, Prevention/Screening.
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