Screening not advised for neck artery narrowing

NEW YORK (Reuters Health) - A major medical advisory group in the U.S. recommends that individuals not be tested for narrowing of the carotid arteries, the major arteries in the neck that supple oxygen to the brain, provided that they have no symptoms of narrowing in the first place.

Carotid artery narrowing or "stenosis" is a common finding in older adults, which can lead to a stroke if it is severe. The condition can be treated with surgical removal of the plaque lining the inside of the arteries that cause the stenosis or with the placement inside the arteries of a stent, a tiny metal tube that maintains an open passage for blood flow.

Based on evidence that screening for symptomless carotid artery stenosis may cause more harm than good, new guidelines from the U.S. Preventive Services Task Force discourage this practice in the general population.

The Task Force's examination of systematic reviews, observational studies, and trials led to three main observations:

--A relatively small proportion of all disabling, unheralded strokes are due to symptomless carotid narrowing.

--Noninvasive screening tests, such as ultrasound and MRI, often yield false-positive results, leading to unnecessary treatment. Invasive screening with X-rays using contrast dye directly injected into blood vessels can cause serious adverse events.

--The benefits of surgical treatment with carotid surgery are judged to be small.

Among adults without neurologic signs or symptoms, "it is not clear how to identify people whose risk for stroke is high enough to justify screening, yet who do not also have a high risk for surgical complications," the authors write in the Annals of Internal Medicine.

SOURCE: Annals of Internal Medicine, December 18, 2007.