Role of Duplex Ultrasound in Carotid Screening

Screening programs designed to identify disease in the general public have proliferated in recent years. Increased stroke awareness has resulted in both free and for-profit screening programs for carotid disease offered to the public. This chapter evaluates the effectiveness of screening for carotid artery disease, which by definition means testing individuals to identify asymptomatic internal carotid disease. The underlying premise of carotid screening is that disease will be identified that increases the patient’s risk for stroke, which then generates treatment that effectively reduces that risk. A literature review of the history of carotid screening for both general and high-risk populations was undertaken, and the cost-effectiveness of screening programs analyzed. Despite the increased interest related to patients with asymptomatic carotid artery stenosis, screening for carotid artery disease is difficult to justify as the prevalence of asymptomatic carotid artery stenosis and risk of subsequent ipsilateral stroke are low in the general public. Moreover, the number of patients needed to screen in order to prevent one stroke is excessive. At present, there are no data supporting screening for asymptomatic carotid disease in individuals appropriately treated for cardiovascular risk reduction. It is unlikely that screening for carotid artery disease will improve patient care or be cost-effective.