USPSTF: No screening for asymptomatic carotid artery stenosis

The general population should not be screened for asymptomatic carotid artery stenosis (CAS) because the risk for stroke is very low, according to draft recommendations by U.S. Preventive Services Task Force (USPSTF) published online Feb. 18.

Based on the available evidence, the group determined with moderate certainty that the risk of harms from screening from CAS outweighed the potential benefits. In study participants with asymptomatic CAS, carotid endarterectomy (CEA) reduced the overall incidence of strokes or perioperative death by 3.5 percent compared with medical management. This effect, however, would not be as great among the general population.

On the other hand, other studies found that CEA was associated with a 30-day stroke or mortality rate that ranged up to 6 percent in certain states. The 30-day stroke or mortality rate after carotid angioplasty and stenting was approximately 3.1 percent to 3.8 percent.

The current recommendation is an update from the 2007 recommendation that also determined the general population should not be screened for CAS. It is in line with recommendations of other societies as well. In 2010, the American Heart Association and the American Stroke Association also recommended against asymptomatic CAS among the general population.

The following year, the American College of Cardiology Foundation and other societies recommended against carotid duplex ultrasound for routine screening in patients with no signs of or risk factors for atherosclerosis. A 2011 Society for Vascular Surgery issued a guideline against routine screening to detect asymptomatic CAS.

The USPSTF draft recommendation statement is open for public comment until March 17.