Goldstein Writes JAMA Editorial on Asymptomatic Carotid Artery Stenosis Screening

Dr. Larry Goldstein, chair of the University of Kentucky’s Department of Neurology, defends and elaborates on a recent statement by the U.S. Preventive Services Task Force (USPTF) in an editorial recently published in The Journal of the American Medical Association (JAMA). The USPTF statement reaffirmed its 2014 recommendation against screening for asymptomatic carotid artery stenosis in the general adult population. That statement was based on evidence that the harms of screening for carotid artery stenosis in asymptomatic adults outweigh the benefits, with no new evidence that would change the previous recommendation.

Goldstein writes, “The rationale for this confirmation is based on a combination of considerations, including the effects of false-positive results when screening the general population with duplex ultrasonography; inadequate evidence that screening for asymptomatic carotid artery stenosis leads to a reduction in stroke or death; and the likelihoods of small to moderate harms of screening for and treatment of asymptomatic carotid artery stenosis.”

He also notes that the restated recommendation is consistent with that of the 2014 guidelines from the American Heart Association not to screen low-risk populations for asymptomatic carotid artery stenosis.

Goldstein says the estimated population-attributable risk for stroke-related to asymptomatic carotid artery stenosis is approximately 0.7%, a risk considerably lower than for other stroke risk factors such as hypertension, atrial fibrillation, cigarette smoking, and hyperlipidemia. “There remains no validated risk stratification tool for identifying a subpopulation of adults with a prevalence of asymptomatic carotid artery stenosis with a higher population-attributable risk that would lead to a benefit of intervention beyond risk factor management,” he explains.

In conclusion, Goldstein writes, “Population-based screening is intended to identify persons with conditions who would have important health benefits from treatments they would not have otherwise received if the condition were not detected. The currently available data clearly support the reaffirmed USPTF recommendation against population screening for asymptomatic carotid artery stenosis.”

To view the entire editorial click here.