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Carotid Conundrum: Role of Ultrasound Screening

The U.S. Preventive Services Task Force (USPSTF) reversed its rating on ultrasound screening for carotid artery stenosis in 2007, and after careful analysis, USPSTF labeled the test grade D, recommending against screening for asymptomatic stenosis in the general population... Carotid artery ultrasound screening also is plagued by less than stellar accuracy. “When screening ultrasound is applied to millions of people over the age of 60, the exam will identify at least as many false positives as true positives,” says Timothy P. Murphy, MD, of Warren Alpert Medical School at Brown University in Providence, R.I. And some of these patients may head down a slippery slope toward revascularization.…

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 Asymptomatic Carotid Artery Stenosis: Screening - Final Recommendation Statement

The USPSTF recommends against screening for asymptomatic carotid artery stenosis in the general adult population. The final recommendation mirrors a draft recommendation posted by the USPSTF in August 2020, and is consistent with the task force’s July 2014 recommendation on the topic. The AAFP supported the 2014 recommendation.

Articles of Interest

Carotid artery ultrasound: Should you have this test?

This screening test is simple and painless, but it isn't appropriate for most people. For years, for-profit companies have mailed offers for health screening tests to homes across the United States. For about $150, you can undergo a series of ultrasound scans, which the companies claim can uncover potentially dangerous cardiovascular conditions. One scan looks at your carotid arteries, which run up either side of your neck.

Is Carotid Artery Ultrasound Still Useful Method for Evaluation of Atherosclerosis?

The controversial circumstances in which carotid ultrasound examination is performed raise questions about the usefulness of carotid IMT measurement in risk stratification.

Some Health Screenings May Harm More Than Help

And while most of the research and advisory panels are nearly unanimous that several tests offered by Life Line and other companies are more likely to cause harm than good for people without symptoms, Manganaro counters that the research those panels cite is out of date. Even people who aren't at major risk can benefit, he says, because the tests push them to change their lifestyles before more damage is done.

The quick carotid scan for prevention of strokes due to carotid artery disease

The only means at the present of reducing strokes from CAD on a large scale is by screening the senior population with the QCS to find the 8% with ACS which can be done in less than I minute and with a sensitivity of 97% to be followed in those positive with a DUS and appropriate stroke preventing management. In addition to the QCS, there is the option of including an ultrasound scan of the abdominal aorta to discover aortic aneurysms prior to rupture and of scanning the common femoral artery to identify arteriosclerotic plaques which have a high correlation with coronary artery disease and can be a trigger for a cardiac and metabolic evaluation

The Scan That Saved My Life

“It is hard to understand how many leaders in the medical profession can object to a one- to two-minute accurate screen of seniors that can find the 7.5% with silent carotid artery disease,” Dr. Lavenson said. Those patients can be “evaluated and managed to prevent them from being one of the 700,000 clot-caused strokes we continue to have annually.”

A Common Test to Screen for Stroke Risk Is Under Review

But the use of carotid-artery screening has been highly controversial, in large part because studies show the ultrasound tests have only moderate sensitivity and can produce false-positive results. Follow-up often leads to more sensitive tests that can actually have adverse effects on the patient; in some cases, people with false-positive test results may end up getting unnecessary invasive surgery, according to the U.S. Preventive Services Task Force, which issued a recommendation in 2007 against screening patients without symptoms of disease.

Be wary of commercial cardiovascular screening services

But the USPSTF discourages screening for carotid artery stenosis, which occurs when fatty deposits build up and narrow the arteries that run up either side of the neck and supply blood to the brain. Dr. Gaziano agrees: "I don't use it as a screening test at all." Not only is this condition very rare, occurring in only about 0.5% to 1% of the population, the ultrasound screening tests produces a high number of false positive results. That triggers a cascade of follow-up invasive tests and other procedures that can cause serious harm, including a heart attack or stroke.

Doctors sound alarm on controversial 'strokecheck' tests

Dr Bourke said the highly regarded US Preventive Services Taskforce reviewed the use of ultrasounds to screen the general population for stroke risk in 2014 and concluded it does more harm than good. The group's report said approximately 0.5 per cent to 1 per cent of the population has carotid artery stenosis and that there is no validated, reliable tool to determine who is at increased risk of the condition – or at risk of a stroke when it is present.

Most Carotid Ultrasounds Performed for Uncertain or Inappropriate Indications

The vast majority of imaging tests that result in carotid revascularization of asymptomatic patients are performed for “uncertain” indications, with as many as one in nine carotid ultrasounds performed for “inappropriate” indications, according to the results of new analysis.

Resolving ultrasound controversies in carotid stenosis

Useful as it is, ultrasound for the diagnosis of internal carotid artery (ICA) stenosis can also be confusing. There is debate about the reporting standards for the degree of stenosis, differences in the Doppler parameters used, and differences in the recommended Doppler thresholds.

Resources

Life Line Screening

We are the leading provider of annual screenings for risks of Cardiovascular Disease, Stroke, and other chronic diseases. Designed by doctors and administered by trained professionals, our screenings can help detect hidden health issues before they become a serious problem. Since 1993, we have screened over 10 million people and provided peace of mind or early detection of health risks.

Screening America

Stroke Screening Program is specifically designed to detect vascular abnormalities in patients 40 years of age and older. The Stroke Screening package includes: An ultrasound of the carotid arteries in the neck, Abdominal Aortic Aneurysm (AAA), Atrial Fibrillation (A Fib), and Peripheral Artery Disease (PAD).