USPSTF reaffirms 2014 recommendation against screening for asymptomatic carotid stenosis

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The United States Preventive Services Task Force (USPSTF) has recommended against screening for asymptomatic carotid artery stenosis in the general adult population—a reaffirmation of the 2014 D recommendation.

The USPSTF statement came in a recommendation statement recently published in the Journal of the American Medical Association (JAMA). The document was written by Alex H. Krist, MD, a professor of family medicine and population health at Virginia Commonwealth University in Richmond, Virginia, and colleagues.

“This recommendation statement is a reaffirmation of the 2014 D recommendation for screening for asymptomatic carotid artery stenosis,” the USPSTF members write in JAMA. “The USPSTF issued the D recommendation based on evidence that the harms of screening for carotid artery stenosis in asymptomatic adults outweigh the benefits. The USPSTF found no new substantial evidence that could change its recommendation and therefore reaffirms its recommendation.”

To arrive at the updated recommendation, the USPSTF commissioned a reaffirmation evidence review to identify new and substantial evidence sufficient enough to change the prior recommendation, the authors explain. “The reaffirmation update focused on the targeted key questions on the potential benefits and harms of screening and interventions, including revascularization procedures designed to improve carotid artery blood flow, in persons with asymptomatic carotid artery stenosis.”

The recommendation applies to adults who do not have a history of transient ischemic attack, stroke, or other neurologic signs or symptoms referable to the carotid arteries, Krist and colleagues write.

The USPSTF does not recommend screening adults without these signs or symptoms, they comment. In terms of treatment for patients with asymptomatic disease, “the harms of surgical interventions compared with appropriate medical therapy appear to outweigh the benefits,” the authors point out.

However, the authors acknowledge that more research is needed in order to evaluate “the benefits and harms of screening for asymptomatic carotid artery stenosis in the general adult population.”

They explain that such investigation would include trials with long-term follow-up (>5 years) that compare carotid endarterectomy (CEA) or carotid artery angioplasty and stenting (CAS) plus contemporary best medical therapy with best medical therapy alone, including completion of ongoing trials.

Further important research would also include the development and validation of tools to determine which persons are at high risk for carotid artery stenosis—and stroke due to carotid artery stenosis—and who might experience harm from treatment with CEA or CAS.

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