The U.S. Preventive Services Task Force (USPSTF) has posted a draft research plan on screening for asymptomatic carotid artery stenosis, an exam that typically involves the use of ultrasound to detect signs of stenosis before a stroke can occur.
The new plan is part of the USPSTF's five-year review of its previous guidance on carotid artery screening, issued in 2014. At that time, the USPSTF gave the procedure a letter grade of D, recommending against its use in asymptomatic individuals.
The low prevalence of carotid artery stenosis would result in many false positives on screening ultrasound, the group concluded in 2014. In addition, a large number of surgical interventions such as carotid endarterectomy could be performed that aren't any better than standard medical therapies such as statins in terms of reducing stroke risk, according to the task force.
The new draft introduces the following questions for review:
- Is there direct evidence that screening asymptomatic adults for carotid artery stenosis with duplex ultrasonography improves health outcomes?
- What are the harms associated with screening for asymptomatic carotid artery stenosis?
- For asymptomatic persons with carotid artery stenosis, does treatment with carotid endarterectomy or carotid angioplasty and stenting provide incremental benefit beyond current standard medical therapy?
- What are the harms associated with carotid endarterectomy or carotid angioplasty and stenting for the treatment of asymptomatic carotid artery stenosis?
The draft research plan is available for public comment from August 15 through September 11, 2019.