Although deaths from stroke have declined steadily over the last 50 years,1 stroke remains the fifth leading cause of death and the primary cause of neurological disability in the United States, where 610 000 first-ever strokes occur each year and more than 146 000 people die.2 Given the devastating consequences of stroke, the goal of identifying who is at high risk to initiate preventive measures remains a high priority.
A total of 34% of strokes are ischemic strokes resulting from carotid artery disease, with the remaining strokes coming from the vertebrobasilar territory, intracranial vessels, or the heart.2 However, most individuals who experience these strokes do not have a moderate or higher stenosis that could have been detected and treated in advance of the stroke; only 14% of strokes result from thromboembolism from a previously asymptomatic stenosis of the internal carotid artery.3 The remaining strokes occur in individuals with at most minor carotid narrowing who would not have been candidates for intervention. Furthermore, some of these 14% of individuals will experience a warning transient ischemic attack, leaving about 11% of individuals whose stroke is due to thromboembolism from a previously asymptomatic stenosis.3 These are the individuals with stroke who could potentially benefit from prior carotid screening. Given that only 11% of strokes are associated with previously undiagnosed carotid stenosis, the impact of ultrasonographic screening on overall stroke prevention is limited, but preventing stroke in individuals with previously undiagnosed carotid stenosis is important, particularly when effective therapies are available.
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Smith-Bindman R, Bibbins-Domingo K. USPSTF Recommendations for Screening for Carotid Stenosis to Prevent Stroke—The Need for More Data. JAMA Netw Open. 2021;4(2):e2036218. doi:10.1001/jamanetworkopen.2020.36218
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