USPSTF Discourages Screening for Asymptomatic Carotid Disease

Shelley Wood

February 18, 2014

ROCKVILLE, MD — The US Preventive Services Task Force has issued a new draft document recommending against screening for carotid artery disease in asymptomatic adults[1]. This "D" recommendation ("discourage the use of this service") is a reaffirmation of similar recommendations issued by the USPSTF in 2007, as reported by heartwire .

The draft document, as well as an evidence report supporting its conclusions, are open for public comment until March 17.

The draft recommendations note that while stroke is a leading cause of death and disability in the US—and that carotid artery stenosis (CAS) is a risk factor for stroke—"only a relatively small proportion of strokes is caused by CAS."

There is no direct evidence that screening for asymptomatic CAS, typically with ultrasonography, leads to fewer strokes, although there is "adequate evidence" that both testing for CAS and treating CAS with carotid endarterectomy "can cause harms." Moreover, ultrasonography in the general population, where CAS prevalence is low, yields "many false-positive results," the statement reads.

Randomized trials and other studies reviewed for this updated recommendation are summarized in the statement, including results of the ACAS, ACST, and VACS trials; however, as the authors note, no studies have specifically examined the direct harms of screening. Another unanswered question is whether carotid endarterectomy or carotid angioplasty is superior to intensive medical therapy alone, a question to be addressed in the planned CREST-2 study.

These updated USPSTF draft recommendations echo recent recommendations developed or endorsed by the American Heart Association and the American Stroke Association, the American College of Cardiology Foundation, the American Association of Neurological Surgeons, the American College of Radiology, the American Society of Neuroradiology, the Society for Vascular Surgery, the Society for Vascular Medicine, and the Society for Vascular Surgery.


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