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Search - Screening for Asymptomatic Carotid Artery Stenosis: Evidence Synthesis Number 50

Screening for Asymptomatic Carotid Artery Stenosis Evidence Synthesis Number 50
Author: U. S. Department of Health and Human Services, Agency for Healthcare Research and Quality

Cerebrovascular disease is the third leading cause of death in the U.S. Approximately 500,000 Americans each year suffer a first stroke. The mortality rate for cerebrovascular disease has declined by nearly 70% since 1950. Much of the decrease is likely due to reduced cigarette smoking and improved control of hypertension. In addition to contro... more »lling such risk factors as tobacco use and hypertension, carotid endarterectomy (CEA) has been proposed as a strategy for reducing the burden of suffering due to stroke. Randomized controlled trials (RCTs) have shown that CEA effectively reduces stroke among people who have severe carotid artery stenosis (CAS) and have had a transient ischemic attack (TIA) or ?minor stroke.? It is not clear, however, whether screening asymptomatic people (i.e., those who have never had a TIA) to detect CAS and treatment with CEA is effective in reducing stroke. In 1996, the USPSTF concluded that there was insufficient evidence to recommend for or against screening of asymptomatic persons for CAS using physical exam or carotid ultrasound. This recommendation was based on new evidence at the time, including the Asymptomatic Carotid Artery Study (ACAS), a RCT involving 1662 subjects with asymptomatic stenosis greater than 60%. Results of ACAS suggested that the overall benefit of treatment with CEA depends greatly on the perioperative complications. At that time, there was limited information about CEA complications in the general population. After a trend of declining usage of CEA, the publication of ACAS led to a reversal and the number of carotid endarterectomies performed in the U.S. increased significantly. Data then began to emerge about complication rates from CEA performed in community and academic settings. Since the previous Task Force review, the largest RCT of CEA versus medical treatment of asymptomatic CAS, the Asymptomatic Carotid Surgery Trial (ACST), has been published. This review updates the 1996 Task Force review of screening for CAS, focusing on duplex ultrasound as the screening test (with various confirmation tests) and CEA as the treatment for clinically important CAS. It draws upon the 1996 recommendation, updates the evidence on the natural history of CAS, the accuracy of screening tests, and the benefits of treatment for CAS with CEA, and includes a systematic review of the evidence since 1994 on the harms of carotid endarterectomy. Medical interventions were not reviewed in this report. The USPSTF has reviewed screening for several identified CAS and stroke factors, including hyperlipidemia, hypertension, aspirin prophylaxis, and smoking. The key questions were: Key Question 1. Is there direct evidence that screening adults with ultrasound for asymptomatic CAS reduces fatal and/or nonfatal stroke? Key Question 2. What is the accuracy and reliability of ultrasound to detect clinically important CAS? Key Question 3. For people with asymptomatic CAS 60%-99%, does intervention with CEA reduce CAS-related morbidity or mortality? Key Question 4. Does treatment for asymptomatic CAS 60%-99% with CEA result in harm?

ISBN-13: 9781490902173
ISBN-10: 1490902171
Publication Date: 7/2/2013
Pages: 44
Rating:

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Publisher: CreateSpace Independent Publishing Platform
Book Type: Paperback
Members Wishing: 0
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Genres:

Medical Books >> Research

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Search - Screening for Asymptomatic Carotid Artery Stenosis: Evidence Synthesis Number 50

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