Key result
Selective screening of high-risk patient subgroups for asymptomatic carotid stenosis provides an opportunity to identify individuals earlier and initiate preventive measures to reduce future cardiovascular events.
Why the study?
Guidelines do not recommend routine population-wide screening for asymptomatic carotid artery stenosis, but selective screening could have several clinical benefits.
Does selective screening for asymptomatic carotid stenosis prevent future strokes and cardiovascular events in high-risk populations?
Does selective screening for asymptomatic carotid stenosis prevent future strokes and cardiovascular events in high-risk populations?
Selective screening for asymptomatic carotid stenosis in high-risk individuals, rather than population-wide screening, is recommended to identify patients who may benefit from intensive medical therapy and risk factor modification to prevent future cardiovascular events.
Selective high-risk screening may enable earlier intensive prevention; leaves open cost-effectiveness and whether guidelines should change.
INTRODUCTION: Two of the main reasons recent guidelines do not recommend routine population-wide screening programs for asymptomatic carotid artery stenosis (AsxCS) is that screening could lead to an increase of carotid revascularization procedures and that such mass screening programs may not be cost-effective. Nevertheless, selective screening for AsxCS could have several benefits. This article presents the rationale for such a program. AREAS COVERED: The benefits of selective screening for AsxCS include early recognition of AsxCS allowing timely initiation of preventive measures to reduce future myocardial infarction (MI), stroke, cardiac death and cardiovascular (CV) event rates. EXPERT OPINION: Mass screening programs for AsxCS are neither clinically effective nor cost-effective. Nevertheless, targeted screening of populations at high risk for AsxCS provides an opportunity to identify these individuals earlier rather than later and to initiate a number of lifestyle measures, risk factor modifications, and intensive medical therapy in order to prevent future strokes and CV events. For patients at 'higher risk of stroke' on best medical treatment, a prophylactic carotid intervention may be considered.
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Paraskevas et al. (2024) conducted a review in Asymptomatic carotid artery stenosis. Selective screening for asymptomatic carotid stenosis vs. Population-wide screening was evaluated. Selective screening of high-risk patient subgroups for asymptomatic carotid stenosis provides an opportunity to identify individuals earlier and initiate preventive measures to reduce future cardiovascular events.
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