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JAMA Clinical Guidelines Synopsis
January 13, 2015

Screening for Asymptomatic Carotid Artery Stenosis

Author Affiliations
  • 1University of Chicago, Section of General Internal Medicine, Chicago, Illinois
JAMA. 2015;313(2):192-194. doi:10.1001/jama.2014.16804

Stroke is the fourth leading cause of death in the United States.1 Each year nearly 800 000 people have a stroke, 600 000 for the first time.1 Atherosclerotic narrowing of the internal carotid arteries—carotid artery stenosis (CAS)—is an important cause of stroke.2 Ninety percent of all strokes are ischemic1 and, of these, 10% are caused by large artery stenosis.3 CAS is initially asymptomatic, with its first manifestation frequently transient ischemic attack or stroke.2 A meta-analysis of international studies suggested a prevalence of asymptomatic CAS of at least 50% (moderate stenosis) in 4.2% of the general population, increasing with age to 7% of women and 12% of men older than 70 years.4 However, most studies suggest a higher 5-year risk of carotid territory ischemic stroke in individuals with severe stenosis (≥70% narrowing), a degree present in only 0.5% to 1% of US cohorts.3

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