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A Methodological Approach to Non-invasive Assessments of Vascular Function and Morphology
Published on: February 7, 2015
Screening test for carotid disease
1Department of Radiology, Ochsner Clinic Foundation, New Orleans, LA 70124, USA. ebluth@ochsner.org
Insights
Screening for carotid artery stenosis using ultrasound (US) may reduce stroke risk. This review examines US screening methods, their accuracy, and cost-effectiveness for stroke prevention.
Area of Science:
- Vascular Surgery
- Neurology
- Public Health
Background:
- Cardiovascular disease is a leading cause of death in the US.
- Carotid endarterectomy trials show reduced stroke risk for symptomatic and asymptomatic patients with carotid artery stenosis.
- Detecting occult carotid stenosis is a proposed stroke-reducing strategy.
Purpose of the Study:
- To review ultrasound (US) methods for carotid artery screening.
- To assess the accuracy of proposed US screening methods.
- To evaluate the cost- and clinical effectiveness of US carotid artery screening.
Main Methods:
- Review of proposed ultrasound (US) screening methods for carotid artery stenosis.
- Analysis of reported accuracy data for US screening techniques.
- Examination of cost-effectiveness and clinical utility studies.
Main Results:
- Ultrasound (US) has been investigated as a screening tool for carotid artery stenosis, both alone and with other screenings.
- Accuracy of various US methods for detecting carotid stenosis is reported.
- Data on cost- and clinical effectiveness are considered.
Conclusions:
- Ultrasound (US) screening for carotid artery stenosis is a potential method for stroke risk reduction.
- Further evaluation of accuracy and cost-effectiveness is crucial for widespread implementation.
- Screening may be beneficial for both symptomatic and asymptomatic individuals.
Abstract:
Because cardiovascular disease is the leading cause of death in the United States, the identification of a screening test to reduce the risk of stroke has been a long-term goal of those interested in public health. The recent European and North American randomized carotid endarterectomy trials have demonstrated that both symptomatic and asymptomatic patients with internal carotid artery stenosis may experience a reduction of stroke risk when treated with endarterectomy. Thus the detection of occult carotid stenosis has been proposed as a stroke-reducing method. US has been studied both as a solitary screening method and in conjunction with hypertension and cardiac arrhythmia screening. This article reviews the methods proposed for US carotid artery screening, the reported accuracy of these methods, and issues of cost- and clinical effectiveness.
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