Patients with carotid artery stenosis are more apt to die from coronary artery disease than strokes. The presence of bruits should prompt a workup for coronary artery disease, where intervention is more likely to be beneficial.
USPSTF Draft Recommendation: Do Not Screen for Asymptomatic Carotid Artery Stenosis — Physician’s First Watch
USPSTF Draft Recommendation: Do Not Screen for Asymptomatic Carotid Artery Stenosis
By Amy Orciari Herman
The U.S. Preventive Services Task Force is once again recommending against screening for asymptomatic carotid artery stenosis in the general population. The draft recommendation statement, available for public comment on the USPSTF website until March 17, reiterates the group's 2007 stance.
Following are some of the task force's reasons for recommending against screening:
The "most feasible" method, ultrasonography, has a high false-positive rate in the general population.
There's no reliable way to determine who with carotid stenosis is at increased risk for stroke.
There's no evidence that adding cardiovascular medications or increasing current dosages to manage asymptomatic stenosis yields any benefit.
Adequate evidence shows that treatment with carotid endarterectomy can cause harm.
The USPSTF concludes "with moderate certainty" that the harms of screening outweigh the benefits.
Reader Comments (4)
I totally Disagree. The Science has been wel Proven with the added benefit of the patient taking gret responsiblity for their Health when this procedure is Done---only with a Certified Ultrasonography. Refer to Dr Bill Cromwell-Dr Marc Penn and hundreds of other Clinicians who find this of great assistance---When used appropriately!!!
R. Graham Reedy, MD
So on exam I am NOT to auscultate the carotids because if the patient has a bruit the recs are not to do anything if asymptomatic?...
Sounds like would need to discuss all the recs , pros, cons, this is just more work like explaining at length why psa is no longer now recommended, everything is taking more extensive documentation why something is not being done .
I agree, there needs to be a balance of risk and benefit. Evidence is sketch to support an embolic aetiology in all patients with transient visual symptoms such as transient monocular blindness (TMB). Carotid endarterectomy may potentially be harmful in patients who suffer from non-embolic TMB [Surv Ophtalmol 2013;58(1):42-62. PMID: 23217587].