Screening for Asymptomatic Carotid Artery Stenosis: USPSTF Recommendations

The following are key points to remember from the United States Preventive Services Task Force (USPSTF) recommendation statement on screening for asymptomatic carotid artery stenosis:

  1. The USPSTF recommended in 2014 against screening for asymptomatic carotid artery stenosis in the general adult population. They re-affirm that same recommendation in this 2021 updated recommendation, given moderate certainty that the harms of screening outweigh the benefits.
  2. Carotid artery stenosis is the atherosclerotic disease that affects extracranial carotid arteries. Although it is a risk factor for stroke and marker for increased risk of myocardial infarction, it causes a relatively small proportion of strokes in the United States.
  3. The recommendation applies to adults without a history of stroke or neurologic signs or symptoms of a transient ischemic attack.
  4. Adequate evidence exists that duplex ultrasonography has a reasonable sensitivity and specificity profile for detecting clinically relevant carotid artery stenosis. However, it may yield false-positive results when used for general population screening.
  5. Auscultation of the neck for carotid bruits has poor accuracy for detecting clinically relevant carotid artery stenosis.
  6. There is inadequate direct evidence that screening for asymptomatic carotid artery stenosis reduces adverse health outcomes (e.g., stroke, mortality). Additionally, there is evidence that treating asymptomatic patients with surgical or catheter-based procedures provides no to small benefit in reducing adverse health outcomes as compared to current medical therapy.
  7. There is inadequate direct evidence that screening for asymptomatic carotid artery stenosis can cause harm. However, there are known harms associated with the confirmatory testing and interventions (e.g., computed tomography, magnetic resonance imaging, and invasive angiography).
  8. The overall magnitude of harms for both screening and treatment in asymptomatic carotid artery stenosis are small to moderate, according to the USPSTF assessment.
  9. This recommendation is in alignment with other society recommendations, including the American Heart Association/American Stroke Association 2014 recommendation. However, the Society for Vascular Surgery and other professional societies suggest consideration of screening in patients with multiple risk factors or known cardiovascular disease (including peripheral artery disease).

Keywords: Angiography, Atherosclerosis, Auscultation, Cardiac Surgical Procedures, Carotid Arteries, Carotid Stenosis, Diagnostic Imaging, Ischemic Attack, Transient, Magnetic Resonance Imaging, Myocardial Infarction, Outcome Assessment, Health Care, Peripheral Arterial Disease, Risk Factors, Secondary Prevention, Stroke, Tomography, Ultrasonography, Vascular Diseases

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