Population: Adults with asymptomatic carotid artery stenosis.
Organizations
USPSTF 2021, CCF/ACR/AIUM/ASE/ASN/ICAVL/SCAI/SCCT/SIR/SVM/SVS 2012, AHA/ASA 2011, AAFP 2015, Society of Thoracic Surgeons 2013
Recommendation
–Do not screen.
Practice Pearls
• The overall US prevalence of internal CAS of ≥70% varies from 0.5% to 1%, with increased prevalence in older adults, smokers, individuals with hypertension or heart disease. No clinically useful risk stratification tool has been found to reliably distinguish between individuals with clinically important CAS and those who do not. No evidence suggests that screening for asymptomatic CAS reduces fatal or nonfatal strokes. (Ann Intern Med. 2014;161(5):356-362)
• Carotid duplex ultrasonography to detect CAS > 70%: 90% sensitivity, 94% specificity. (Ann Intern Med. 2014;161(5):356-362)
• In 2021, USPSTF reviewed evidence since 2014 and did not change the recommendation.
Sources
–USPSTF. JAMA. 2021;325(5):476-481.
–ACCF/ACR/AIUM/ASE/ASN/ICAVL/SCAI/SCCT/SIR/SVM/SVS. J Am Coll Cardiol. 2012;60(3):242-276.
–ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS. Circulation. 2011;124:e54-e130.
–AAFP. Am Fam Physician. 2015;91(10):online.
–Choosing Wisely: Society of Thoracic Surgeons. 2013.