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Caution Urged in Screening for Carotid Artery Stenosis

Recommendations issued for ultrasonography, endarterectomy of asymptomatic patients

WEDNESDAY, Dec. 19 (HealthDay News) -- The number of strokes that would be avoided by screening asymptomatic individuals for carotid artery stenosis and treatment with carotid endarterectomy is too low to justify the potential risks, researchers report in the Dec. 18 issue of the Annals of Internal Medicine.

Tracy Wolff, M.D., of the Agency for Healthcare Research and Quality in Rockville, Md., and colleagues conducted MEDLINE and Cochrane Library database searches on behalf of the U.S. Preventive Services Task Force. The current study is an update of a 1996 review of the same issues, and is published together with a recommendation statement. The review examined four key questions, including whether there is evidence that duplex ultrasonography for asymptomatic carotid artery stenosis reduces the incidence of stroke, and whether screening or treatment with carotid endarterectomy for asymptomatic carotid artery stenosis results in harm.

No direct evidence was found of the benefit of carotid artery stenosis screening in asymptomatic adults. Some studies found that treatment with carotid endarterectomy for asymptomatic carotid artery stenosis resulted in an absolute reduction in stroke of approximately 5 percent over five years, although the study populations were narrow. Reported harms of such surgery in the random clinical trials reviewed varied from 2.7 to 4.7 percent.

"Until we address the gaps in the evidence that screening and treatment with carotid endarterectomy provides overall benefits to the general population, clinicians' efforts might be more practically focused on optimizing medical management," the authors conclude.

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