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USPSTF advises against ultrasound screening to prevent stroke
Last week, the United States Preventative Services Task Force (USPSTF) advised against ultrasound screening for carotid artery stenosis as a means to prevent stroke in its finalized draft recommendation published in the Annals of Internal Medicine. It was an update to their 2007 recommendation.
To date, the best method to screen for carotid artery stenosis is with ultrasound because of its high sensitivity and specificity. However, it often leads to many false-positive results in the general population.
Stroke is a leading cause of mortality in the U.S. and accounts for nearly 130,000 deaths every year, according to the Centers for Disease Control and Prevention. Asymptomatic carotid artery stenosis is one of the risk factors for stroke but it only causes a small percentage of the condition.
There is currently no proven reliable external test to determine if a patient is at risk for carotid artery stenosis or for stroke if the patient has the risk factor - screening by auscultation of the neck is proven to be ineffective. Additionally, there isn't any direct evidence of the benefits of screening for carotid artery stenosis.
The USPSTF did note that when carotid endarterectomy (CEA) was performed, after detecting asymptomatic carotid artery stenosis with ultrasound, by selected surgeons on selected trial participants, there was evidence that it decreases the occurrence of stroke or perioperative death by about 3.5 percent compared to dated medical management. But benefits would be less for the general population and the difference is most likely smaller now with current medical management.
The recommendation stated that even though screening with ultrasound doesn't cause direct harm, all screening methods including those with or without confirmatory tests don't have ideal sensitivity and specificity, which can result in needless interventions.
CEA is known to have a 30-day stroke or mortality rate of about 2.4 percent. In low-volume centers the rates can be as high as about 5 percent and in some states it's up to 6 percent. After CEA, between .8 and 2.2 percent of patients experience myocardial infarctions.
The USPSTF concluded the draft recommendation by stating that "with moderate certainty" the harms of screening for asymptomatic carotid artery stenosis outweigh the benefits.
