Your Health: Carotid Artery Screening
A recent Your Health article described how screening for coronary artery disease can be done, but in most cases is not very helpful, compared to simply working on lowering risk of blood vessel disease with healthy lifestyle, including checking blood pressure, blood sugar, and cholesterol. The coronary test requires a CT, which requires an order from the physician.
People also hear about the possibility of screening for narrowing of the carotid arteries in the neck, because this only requires an ultrasound, which can be done at screening events without a physician’s order. The advertising usually encourages people to “prevent a stroke” by doing such a screening. It turns out not to be able to prevent a stroke, by itself at least.
A thorough study by the United States Preventive Services Task Force (USPSTF), first in 2014 and repeated again now, actually recommends against testing in people who have not had symptoms. This means they have never had a previous small stroke, or a transient (short lived) ischemic attack (TIA), which is like a stroke but with a full recovery within a day or two, or any other neurologic symptoms related to the carotid, such as transient loss of vision. Studies have shown that most people who have a permanent stroke have indeed had one of these warning signs previously, and they should have studies done to look at their vessels.
In asymptomatic people, however, the risk of a test being inaccurate, and ending up with a surgical procedure they didn’t need, makes the screening actually dangerous. Surgery for carotid artery disease carries significant risk of stroke or death by itself, and is recommended only as a rather desperate measure for people who are known to be at serious risk of stroke without it. Science actually points to the value of “letting a sleeping dog lie” in this case. This recommendation might change in future years if surgical treatment becomes safer.
The USPSTF has an interesting website (uspreventiveservicestaskforce.org) which has leads to many topics, especially risk factors for stroke including high blood pressure, high cholesterol, diabetes, obesity, exercise, and recommends checking on all of these, which can actually be preventive. A stroke itself can often be treated, so even without symptoms one need to be aware of the actual signs of a stroke, so they are ready to call for emergency treatment immediately if they do have symptoms of a stroke. This is now considered an emergency just like a heart attack.