Con or Common Sense? A review of asymptomatic carotid artery screening

Abstract

Stroke is the second highest cause of death and third leading cause of disability worldwide. Ischaemic strokes are caused by embolism and cerebrovascular disease, the latter of which can be detected at high rates of sensitivity and specificity with duplex ultrasound. Screening for asymptomatic carotid artery stenosis (ACAS) remains highly controversial. Partly to blame is the prevalence of for-profit organisations encouraging the public to have ‘check-up’ style imaging that may detect ACAS. This is one of the reasons for numerous healthcare boards, most notably the US Preventive Task Board in 2014, issuing recommendations against asymptomatic carotid artery screening, citing that it would yield too many false positives and may actually do more harm than good. There are contrasting opinions on the screening of ACAS in Australia however there is no official position on this topic. A properly designed program that selects asymptomatic patients based on risk factors with scans performed by accredited vascular laboratories can provide for the assessment of overall cardiovascular health. This has been demonstrated by The Atherosclerosis Risk in Communities study. We propose a multidisciplinary program for these select patients that may improve outcomes, at risk patient awareness and empower long term lifestyle modification.