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Screening for asymptomatic carotid artery stenosis

Mark O McCarron, MD, FRCP
Larry B Goldstein, MD, FAAN, FANA, FAHA
David B Matchar, MD
Section Editors
Scott E Kasner, MD
Joann G Elmore, MD, MPH
Deputy Editor
John F Dashe, MD, PhD


Progression of atheromatous plaque at the cervical carotid artery bifurcation results in luminal narrowing, often accompanied by ulceration. This process can be asymptomatic, but may lead to ischemic stroke or transient ischemic attack from embolization, thrombosis, or hemodynamic compromise.

This topic will review screening for asymptomatic carotid atherosclerotic disease. The management of asymptomatic carotid disease is discussed separately. (See "Management of asymptomatic carotid atherosclerotic disease".)

Other aspects of carotid occlusive disease are reviewed elsewhere. (See "Pathophysiology of symptoms from carotid atherosclerosis" and "Evaluation of carotid artery stenosis" and "Management of symptomatic carotid atherosclerotic disease".)


Asymptomatic cervical carotid atherosclerotic disease refers to the presence of atherosclerotic narrowing of the extracranial internal carotid artery in individuals without a history of ipsilateral carotid territory ischemic stroke or transient ischemic attack (TIA) [1-3].

Symptomatic carotid disease is defined as focal neurologic symptoms (eg, amaurosis fugax, contralateral weakness or numbness of an extremity or the face, dysarthria or aphasia) in the distribution of a carotid artery with a significant stenosis. Atherosclerotic carotid disease is considered symptomatic if the ipsilateral symptoms occurred within the previous six months. Importantly, nonspecific neurologic symptoms (eg, dizziness, lightheadedness) are not indicative of carotid stenosis. Therefore, patients with these symptoms in isolation should be considered as asymptomatic with regard to carotid disease even if they are found to have carotid artery stenosis. (See "Management of symptomatic carotid atherosclerotic disease", section on 'Definition of symptomatic disease'.)

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Literature review current through: Nov 2017. | This topic last updated: Mar 10, 2016.
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  1. Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA 1995; 273:1421.
  2. Chambers BR, Donnan GA. Carotid endarterectomy for asymptomatic carotid stenosis. Cochrane Database Syst Rev 2005; :CD001923.
  3. Halliday A, Mansfield A, Marro J, et al. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet 2004; 363:1491.
  4. O'Leary DH, Polak JF, Kronmal RA, et al. Distribution and correlates of sonographically detected carotid artery disease in the Cardiovascular Health Study. The CHS Collaborative Research Group. Stroke 1992; 23:1752.
  5. de Weerd M, Greving JP, Hedblad B, et al. Prevalence of asymptomatic carotid artery stenosis in the general population: an individual participant data meta-analysis. Stroke 2010; 41:1294.
  6. Chambers BR, Norris JW. Clinical significance of asymptomatic neck bruits. Neurology 1985; 35:742.
  7. Pickett CA, Jackson JL, Hemann BA, Atwood JE. Carotid bruits and cerebrovascular disease risk: a meta-analysis. Stroke 2010; 41:2295.
  8. McColgan P, Bentley P, McCarron M, Sharma P. Evaluation of the clinical utility of a carotid bruit. QJM 2012; 105:1171.
  9. Wolf PA, Kannel WB, Sorlie P, McNamara P. Asymptomatic carotid bruit and risk of stroke. The Framingham study. JAMA 1981; 245:1442.
  10. Shorr RI, Johnson KC, Wan JY, et al. The prognostic significance of asymptomatic carotid bruits in the elderly. J Gen Intern Med 1998; 13:86.
  11. Van Ruiswyk J, Noble H, Sigmann P. The natural history of carotid bruits in elderly persons. Ann Intern Med 1990; 112:340.
  12. Bogousslavsky J, Despland PA, Regli F. Asymptomatic tight stenosis of the internal carotid artery: long-term prognosis. Neurology 1986; 36:861.
  13. Autret A, Pourcelot L, Saudeau D, et al. Stroke risk in patients with carotid stenosis. Lancet 1987; 1:888.
  14. Pickett CA, Jackson JL, Hemann BA, Atwood JE. Carotid bruits as a prognostic indicator of cardiovascular death and myocardial infarction: a meta-analysis. Lancet 2008; 371:1587.
  15. Chambers BR, Norris JW. Outcome in patients with asymptomatic neck bruits. N Engl J Med 1986; 315:860.
  16. Heyman A, Wilkinson WE, Heyden S, et al. Risk of stroke in asymptomatic persons with cervical arterial bruits: a population study in Evans County, Georgia. N Engl J Med 1980; 302:838.
  17. Goldstein LB. Screening for asymptomatic carotid artery stenosis: caveat emptor. Ann Intern Med 2014; 161:370.
  18. Jahromi AS, Cinà CS, Liu Y, Clase CM. Sensitivity and specificity of color duplex ultrasound measurement in the estimation of internal carotid artery stenosis: a systematic review and meta-analysis. J Vasc Surg 2005; 41:962.
  19. Matchar DB, Pauk JS, Lipscomb J. A health policy perspective on carotid endarterectomy: Cost, effectiveness, and cost-effectiveness. In: Surgery for Cerebrovascular Disease, Moore W (Ed), Saunders, Philadelphia 1996. p.680.
  20. Brett AS, Levine JD. The case against identifying carotid stenosis in asymptomatic patients. JAMA Intern Med 2014; 174:2004.
  21. Jonas DE, Feltner C, Amick HR, et al. Screening for asymptomatic carotid artery stenosis: a systematic review and meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med 2014; 161:336.
  22. Wolff T, Guirguis-Blake J, Miller T, et al. Screening for carotid artery stenosis: an update of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2007; 147:860.
  23. LeFevre ML, U.S. Preventive Services Task Force. Screening for asymptomatic carotid artery stenosis: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2014; 161:356.
  24. Goldstein LB, Bushnell CD, Adams RJ, et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42:517.
  25. Brott TG, Halperin JL, Abbara S, et al. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease. Stroke 2011; 42:e464.