Carotid Artery Stenosis Screening Not Recommended for All

USPSTF recommends against carotid artery stenosis screening in asymptomatic adults

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Screening can detect certain diseases in the early stages, possibly increasing the chances of successful treatment. However, in some cases, screening a whole population can lead to more harm than good.

The United States Preventive Services Task Force (USPSTF) has recommended against screening for carotid artery stenosis in adults with no symptoms.

Carotid artery stenosis is the narrowing of the arteries that supply oxygenated blood to the head and neck. The condition is a risk factor for stroke.

This USPSTF recommendation comes after a review of research that found no evidence of a benefit from screening the general adult population for carotid artery stenosis.

In fact, the review found that screening may slightly raise certain risks associated with the procedures that may be used after positive screening results. These risks may include stroke, heart attack and even death.

"Tell your primary care doctor if you have a history of stroke."

Stroke is one of the leading causes of death and disability in the United States. Even though asymptomatic carotid artery stenosis can raise the risk for stroke, it causes fewer strokes than other risk factors like high blood pressure or diabetes.

According to the USPSTF, ultrasonography — an imaging tool that uses sound waves to visualize the inside of the body — is the most convenient screening tool for carotid artery stenosis. However, the test may lead to many false-positives, or results that show carotid artery stenosis when it actually isn't there.

While the ultrasonography itself causes little harm, false-positive results can lead to unnecessary interventions. One such intervention is called carotid endarterectomy, a procedure in which a surgeon removes the inner lining of the carotid artery to remove plaque and restore blood flow.

The USPSTF found that carotid endarterectomy was associated with small increases in risk for heart attack, stroke and death. However, those risks varied depending on the patient population, surgeon and the specific surgery center.

The Task Force did find some benefit to carotid endarterectomy in some trial participants with asymptomatic carotid artery stenosis. In these patients, the procedure reduced the rate of all strokes or death around the time of surgery by about 3.5 percent.

The Task Force noted, however, that "this difference is probably smaller with current optimal medical management."

This USPSTF recommendation is an update to a 2007 recommendation, which also stated that the general adult population should not be screened for asymptomatic carotid artery stenosis.

The USPSTF report outlining the current recommendation was published online July 8 in the Annals of Internal Medicine.

Review Date: 
July 7, 2014
Last Updated:
July 8, 2014