Health & Medicine

Screening of carotid artery may result in needless, risky surgery

Larry Goldstein
Larry Goldstein

Although technology is extremely useful in the diagnosis and treatment of disease, it’s important to consider many factors before a test is performed. This is particularly true for screenings that are used to detect specific conditions in the general population.

Carotid ultrasound has come under fire as a test whose value might not merit its widespread use for identifying a narrowing of a carotid artery in people with no recent symptoms.

You have two carotid arteries, one on each side of your neck. Carotid ultrasound is a painless and harmless test that uses sound waves to create pictures of the insides of these arteries, looking for plaque that can reduce the flow of blood to the brain and/or cause a stroke.

There are both medical and surgical treatment options for people with a narrowing of a carotid artery. As with all surgeries, a procedure to widen the carotid artery carries risk, including the risk of stroke or even death.

A recent study in the Journal of the American Medical Association/Internal Medicine evaluated the reasons that carotid ultrasound was performed in patients who later had a procedure to open the artery. The majority of the tests were done for uncertain or inappropriate reasons.

The US Preventive Services Task Force and the American Heart Association agree that screening the general population without atherosclerosis for a narrowing of the carotid artery is not useful. However, other professional groups have conflicting guidelines.

Doctors don’t want to miss any opportunity to prevent you from having a stroke. But advances in medical therapy have made it uncertain whether there is a benefit of placing a stent (wire mesh tube) or surgically opening the narrowing in people who have not had relevant symptoms such as temporary or permanent problems with speech, vision, or weakness of an arm or leg.

Research is in progress to help answer this question.

Today, patients are more in control of their health care choices. The doctor is a partner in the maintenance of good health, which is a welcome and mutually beneficial change. It’s our responsibility to consider why certain tests — including carotid ultrasound — make sense and to discuss options carefully with our patients.

In turn, patients should make sure they understand their risk factors for stroke and cardiovascular disease and work with their doctors to take steps that reduce their risks. That includes asking questions to make sure you understand your situation and taking advantage of the wealth of resources available from your doctor and from other reputable sources such as the American Heart Association.

Understanding the complexity involved in determining whether to do a test can help you have an informed discussion with your health care provider.

Dr. Larry Goldstein is chairman of the UK Department of Neurology and Co-Director of the Kentucky Neuroscience Institute.

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