USPSTF Issues Final Recommendation Against Screening for Asymptomatic Carotid Artery Stenosis

February 2, 2021—The United States Preventive Services Task Force (USPSTF) announced the publication of a final recommendation statement on screening for carotid artery stenosis (CAS) in people without a history of or signs or symptoms of a blocked artery in the neck. Based on the evidence, the USPSTF continues to recommend against screening for CAS. This recommendation is Grade D: Not Recommended. This final recommendation statement applies to adults without a history of stroke, transient ischemic attack, or other signs or symptoms of stroke, advised USPSTF.

The Task Force’s final recommendation statement and corresponding evidence summary have been published by Janelle M. Guirguis-Blake, MD, et al in the Journal of the American Medical Association (2021;325:487-489). It is also available on the USPSTF website, uspreventiveservicestaskforce.org.

According to USPSTF, there is little evidence that screening for CAS in people without signs or symptoms prevents stroke or reduces mortality. Existing screening methods, especially in the general population, often have false-positive results. Therefore, screening for CAS often leads to unnecessary follow-up testing and surgeries that can cause serious harms, including stroke, heart attack, or death.

The Task Force advised that it has several evidence-based recommendations that can help clinicians and patients prevent stroke through preventive medications, behavioral counseling, and other interventions.

“The Task Force wants to help prevent people from having a stroke, but screening for CAS is not an effective way to do so,” commented USPSTF member Michael J. Barry, MD, in the announcement. “Unfortunately, screening for CAS in adults without symptoms does more harm than good, and we continue to recommend against it.”

USPSTF member Aaron B. Caughey, MD, added, “Screening for CAS does not prevent strokes, but healthy lifestyle choices can. People can reduce their risk of cardiovascular disease, including strokes, by controlling high blood pressure and cholesterol, maintaining a healthy weight, being physically active, eating a healthy diet, and not smoking.”

Dr. Barry is Director of the Informed Medical Decisions Program in the Health Decision Sciences Center at Massachusetts General Hospital; Professor of Medicine at Harvard Medical School; and a clinician at Massachusetts General Hospital in Boston, Massachusetts. Dr. Caughey is a professor in and chair of the Department of Obstetrics and Gynecology and the Associate Dean for Women’s Health Research and Policy at Oregon Health & Science University in Portland, Oregon.