Screening for Asymptomatic Carotid Artery Stenosis: A Systematic Review and Meta-analysis for the U.S. Preventive Services Task Force

@article{Jonas2014ScreeningFA,
  title={Screening for Asymptomatic Carotid Artery Stenosis: A Systematic Review and Meta-analysis for the U.S. Preventive Services Task Force},
  author={Daniel E. Jonas and Cynthia Feltner and Halle R. Amick and Stacey L. Sheridan and Zhi‐Jie Zheng and Daniel J Watford and Jamie L. Carter and Cassandra J Rowe and Russell P. Harris},
  journal={Annals of Internal Medicine},
  year={2014},
  volume={161},
  pages={336-346}
}
Stroke is a leading cause of death and disability (1). An estimated 7 million U.S. adults have had a stroke, and roughly 75% were first attacks (2). Ischemic strokes account for nearly 90% of all strokes in the United States (3). Carotid artery stenosis (CAS) causes approximately 10% of ischemic strokes (4). Carotid artery stenosis refers to atherosclerotic narrowing of the extracranial carotid arteriesspecifically, the internal carotid arteries or the common and internal carotid arteries. The… 
Rationale for screening selected patients for asymptomatic carotid artery stenosis
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Screening high-risk individuals for ACS would enable timely identification of patients with ACS and implementation of BMT and lifestyle measures to prevent future strokes and cardiac events.
Screening for asymptomatic carotid artery stenosis: U.S. Preventive Services Task Force recommendation statement.
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The USPSTF recommends against screening for asymptomatic carotid artery stenosis in the general adult population, applying to adults without a history of transient ischemic attack, stroke, or other neurologic signs or symptoms.
The Benefit of Ultrasound Screening of Asymptomatic Carotid Stenosis in Diabetic Patients with Coronary Artery Disease
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This study is the first to suggest that US does not prevent strokes in high risk subgroups, and might lead clinicians to consider carotid US as a screening tool for stroke prevention.
Prevalence and risk factors for atherosclerotic carotid stenosis and plaque
TLDR
This population-based screening study revealed that Atherosclerotic carotid stenosis was uncommon and had a prevalence of 1.1% in the study population and age, hypertension, and smoking were risk factors for ACS.
Carotid Artery Plaques, Carotid Intima–Media Thickness, and Risk of Cardiovascular Events and All-Cause Death in Older Adults: A 5-Year Prospective, Community-Based Study
TLDR
These findings provide direct evidence of the independent predictive value of the severity of asymptomatic CAS for the development of CVD in older Chinese adults.
The Association between Ideal Cardiovascular Health Metrics and Extracranial Carotid Artery Stenosis in a Northern Chinese Population: A Cross-Sectional Study
TLDR
A negative correlation between the ideal CVH metrics and the prevalence of extracranial CAS in northern Chinese adults was showed, particularly evident in women and the elderly (≥60 years).
Carotid artery stenosis screening: where are we now?
TLDR
Given the low prevalence of stenosis in the general population and the risks associated with undergoing surgical intervention, population wide screening for carotid artery stenosis is not recommended and this recommendation has not changed over the last 15 years.
Carotid Artery Angioplasty and Stenting for Carotid Stenosis: A Single-Center Experience from Saudi Arabia
TLDR
The experience of CAAS is shared to call for the necessity of conducting more research on stroke and emphasize the local need of utilizing more endovascular treatments like CAAS.
Screening for Asymptomatic Carotid Artery Stenosis: Caveat Emptor
TLDR
There is no validated risk-stratification tool that can reliably identify a subpopulation of persons with a prevalence of asymptomatic CAS approaching this level, and carotid duplex ultrasonography is the primary means of noninvasive screening for asymPTomatic CAS.
Prevalence of asymptomatic carotid artery stenosis in Chinese patients with lower extremity peripheral arterial disease: a cross-sectional study on 653 patients
TLDR
The prevalence of significant ACAS (stenosis ≥50%) in patients with PAD was approximately 19.6%.
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References

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Screening for Carotid Artery Stenosis: An Update of the Evidence for the U.S. Preventive Services Task Force
TLDR
On the basis of population-based studies and the accuracy of ultrasonography, the actual prevalence of clinically important CAS is estimated to be approximately 1% or less in the general primary care population and about 1% in persons age 65 years or older.
Noninvasive Carotid Artery Testing: A Meta-analytic Review
TLDR
The purpose was to estimate the sensitivity and specificity of noninvasive carotid artery tests using formal meta-analysis and to determine which tests are the most discriminating in the detection of carotID artery occlusion and severe disease.
Who Should Be Screened for Asymptomatic Carotid Artery Stenosis? Experience From the Western New York Stroke Screening Program
TLDR
A simple scoring system based on routinely available information to identify persons at high risk for ACAS using data collected during a community health screening program at various sites in western New York is developed and validated.
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High peak systolic velocities consistent with high-grade carotid stenosis were uncommon and risk of subsequent cerebrovascular disease outcomes was relatively low, and it is not suggested that similar populations of older adults would benefit from a program using ultrasound to screen for asymptomatic carotids stenosis.
Screening for Carotid Artery Stenosis: U.S. Preventive Services Task Force Recommendation Statement
  • Medicine
    Annals of Internal Medicine
  • 2014
TLDR
Adults who do not have symptoms or a history of transient ischemic attack or stroke should not be screened for carotid artery stenosis, and the benefits of surgery for people with the condition but no symptoms are minimal.
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TLDR
The AsymPTomatic Carotid Atherosclerosis Study will determine whether the addition of carotid endarterectomy to aspirin plus risk factor modifications affects the incidence of ipsilateral transient ischemic attack, amaurosis fugax, and retinal and cerebral infarction in patients with asymptomatic hemodynamically significant carotids stenosis in at least one artery.
Predictive Power of Duplex Ultrasonography in Asymptomatic Carotid Disease
TLDR
The ability of initial and repeated ultrasonography of the carotid arteries to predict the occurrence of TIA, stroke, and death was focused on.
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