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Screening for Carotid Artery Stenosis: U.S. Preventive Services Task Force Recommendation Statement FREE

[+] Article and Author Information

The full report is titled “Screening for Asymptomatic Carotid Artery Stenosis: U.S. Preventive Services Task Force Recommendation Statement.” It is in the 2 September 2014 issue of Annals of Internal Medicine (volume 161, pages 356-362). The author is M.L. LeFevre, on behalf of the U.S. Preventive Services Task Force.

This article was published online first at www.annals.org on 8 July 2014.


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Ann Intern Med. 2014;161(5):I-28. doi:10.7326/P14-9030
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Who developed these guidelines?

The U.S. Preventive Services Task Force (USPSTF) is a group of health experts that makes recommendations about preventive health care.

What is the problem and what is known about it so far?

The carotid arteries are blood vessels in the neck that bring blood to the brain. Carotid artery stenosis (CAS) is a condition caused by cholesterol buildup in the carotid arteries that prevents normal blood flow to the brain. This condition can cause transient ischemic attack or stroke. Transient ischemic attack, sometimes called a “mini-stroke,” is caused by a temporary blockage of blood flow to the brain and does not cause serious long-term brain damage. In stroke, blockage lasts long enough that some brain tissue dies. Although CAS is a risk factor for stroke, only a small proportion of strokes without symptoms are related to it.

The first test for CAS is ultrasonography, which uses sound waves to take pictures of the arteries. Some physicians may do angiography or other tests to confirm the results of the ultrasonography. In angiography, dye is injected into the bloodstream before x-ray pictures of the arteries are taken. This procedure can sometimes cause a stroke.

Treatment of CAS includes careful management of blood pressure, cholesterol, and diabetes to prevent strokes. Surgery can also be performed to remove or bypass the blockages.

Some experts believe that people at high risk for CAS who do not have symptoms should routinely get screening tests. Routine screening would allow those who screen positive to get surgery or other treatments to decrease their chances of future stroke. However, screening could also lead to unnecessary tests and their associated complications in some people who would never develop transient ischemic attack or stroke from CAS.

In 2007, the USPSTF recommended against screening for CAS. The USPSTF wanted to update these recommendations on the basis of new information that may have become available since 2007.

How did the USPSTF develop these recommendations?

The USPSTF reviewed published research to evaluate the benefits and harms of doing routine carotid ultrasonography in healthy adults to identify those who have CAS without symptoms.

What did the authors find?

The authors found evidence that screening with ultrasonography often gives false-positive results in the general population. There is no direct evidence on the benefits of screening for CAS. The benefits of surgery for people with the condition but no symptoms are minimal, especially compared with optimal medical management of blood pressure, cholesterol, and diabetes. Yet, harms result from both testing and treatment with surgery. Strokes or death happen within 30 days of carotid artery surgery in about 3 of every 100 people who have the procedure.

What does the USPSTF recommend that patients and doctors do?

Adults who do not have symptoms or a history of transient ischemic attack or stroke should not be screened for CAS.

What are the cautions related to these recommendations?

The recommendations apply only to patients without symptoms or a history of CAS but may change as new studies become available. People with symptoms of a stroke should see their physician immediately.

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Comments

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Asymptomatic ( screening) carotid stenosis
Posted on July 8, 2014
Sam Wong, MD FACP
none
Conflict of Interest: None Declared
What do you do if an under-educated clinician (including doctors) orders a "routine" carotid ultrasound and end up with a 70-99% ICA obstruction? These clinicians often get us evidence-based physicians in trouble by sue-happy lawyers and patients.
Submit a Comment

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