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Task Force Recommends Against Screening Healthy Adults for Carotid Artery Stenosis

Screening can lead to false-positive results and unnecessary harm

The U.S. Preventive Services Task Force has published a final recommendation statement and final evidence summary on screening adults for carotid artery stenosis (CAS), recommending against screening in the general adult population.

CAS is one of many risk factors for stroke, which is a leading cause of death and disability in the U.S.

“Screening for carotid artery stenosis often leads to follow-up testing and surgeries that can cause serious harms, including stroke, heart attack, or death,” said task force member Jessica Herzstein, MD, MPH. “Also, CAS is uncommon in the general adult population, so screening everyone would lead to many false-positive results.”

The new recommendation applies only to people without symptoms or a history of stroke. Adults with a history of stroke or of transient ischemic attack (“mini-stroke”), or those with signs and symptoms of stroke, are not included in the recommendation and should seek the advice of their clinicians.

“The best way to prevent a stroke and other cardiovascular diseases is to focus on the things we know work,” said task force chair Michael LeFevre, MD, MSPH. “This includes controlling high blood pressure and cholesterol, not smoking, being physically active, maintaining a healthy weight, and eating a healthful diet.”

In their report, the task force noted that the use of ultrasonography in low-prevalence populations would yield many false-positive results, given its specificity (range, 88% to 94% for CAS of ≥ 50% to ≥ 70%). Further, they found that the 30-day rates of stroke or death after carotid endarterectomy in clinical trials and cohort studies were 2.4% (six trials; N = 3,435) and 3.3% (seven studies; N = 17,474), respectively. Other harms of interventions included myocardial infarction, nerve injury, and hematoma.

The task force’s final recommendation statement was published online in the Annals of Internal Medicine, as well as on the group’s Web site.

Sources: USPSTF; July 8, 2014; and Annals of Internal Medicine; July 8, 2014.

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