The USPSTF recommends against screening for asymptomatic carotid artery stenosis (CAS) in the general adult population (Grade D recommendation), reaffirming its 2007 recommendation.
The USPSTF concludes that the harms of screening for asymptomatic CAS outweigh the benefits, and considered different factors to reach this conclusion: A number of professional societies, which include American Association of Neurological Surgeons, American College of Cardiology Foundation, American College of Radiology, and American Heart Association, also recommend against routine CAS screening in the asymptomatic general population.
- Prevalence of CAS is low (0.5% to 1%) and only a relatively small proportion of strokes are caused by CAS.
- Although ultrasonography, the most feasible screening test for CAS, has high sensitivity and specificity, the test yields many false-positive results due to low prevalence of CAS. Additionally, there are no validated, reliable tools that can determine populations who can benefit from detection and early intervention of CAS.
- Benefits of detection and early intervention are small to none for the general population.
- The overall magnitude of harms of detection and early intervention is moderate. Although screening with ultrasonography has only a few direct harms, it can lead to unnecessary interventions and result in more serious complications. Interventions for CAS include carotid endarterectomy (CEA) and carotid angioplasty and stenting (CAAS), and can cause death, stroke and myocardial infarction.
With no change in recommendation, payers will not need to change the coverage policy for CAS screening. The USPSTF called for further research on valid and reliable tools for determining which persons are at high risk for CAS or stroke from CAS and who might experience harm from treatment with CEA or CAAS. The planned CREST-2 (Carotid Revascularization Endarterectomy versus Stenting-2) study is expected to provide important data for future recommendations regarding screening and CAS treatment decisions.
Comments on the USPSTF draft recommendation and supporting evidence report are due March 17.
To read the USPSTF’s full draft recommendation, click here.