Putting Prevention into Practice
An Evidence-Based Approach
Screening for Asymptomatic Carotid Artery Stenosis
Am Fam Physician. 2021 May 15;103(10):623-624.
Author disclosure: No relevant financial affiliations.
A 67-year-old man comes to your office for a regularly scheduled visit. He has type 2 diabetes mellitus and a 40-pack-year smoking history, but he quit smoking two years ago. He takes lisinopril and atorvastatin (Lipitor); his blood pressure today is normal. His A1C and lipid panel at his last visit were within normal limits. He says that he feels well and has no neurologic complaints or any other symptoms. His father had a stroke at 68 years of age and was told it was caused by a blocked artery in his neck. The patient asks whether he should be screened for the same kind of blockage.
Case Study Questions
1. Based on the U.S. Preventive Services Task Force (USPSTF) recommendation statement, how should this patient be counseled?
A. He should not be screened for carotid artery stenosis; his hypertension and hypercholesterolemia are well controlled with medication, so he is not at high risk of carotid artery stenosis.
B. He should be screened for carotid artery stenosis because he has more than two risk factors for a stroke.
C. He should be screened for carotid artery stenosis because he is older than 65 years and has a history of cigarette smoking.
D. He should not be screened for carotid artery stenosis because he has no personal history of transient ischemic attack, stroke, or neurologic symptoms.
E. He should be screened for carotid artery stenosis with carotid duplex ultrasonography, magnetic resonance angiography, or computed tomography angiography.
2. Which of the following factors increase this patient's risk of carotid artery stenosis?
A. Male sex.
B. History of cigarette smoking.
C. First-degree relative with carotid artery stenosis.
3. Which one of the following statements represents the USPSTF's findings on the potential benefits and harms of screening for carotid artery stenosis?
A. The USPSTF found adequate evidence that screening for carotid artery stenosis reduces adverse health outcomes such as stroke, myocardial infarction, and
1. Krist AH, Davidson KW, Mangione CM, et al. Screening for asymptomatic carotid artery stenosis: US Preventive Services Task Force recommendation statement. JAMA. 2021;325(5):476–481.
2. Guirguis-Blake JM, Webber EM, Coppola EL. Screening for asymptomatic carotid artery stenosis in the general population: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2021;325(5):487–489.
This PPIP quiz is based on the recommendations of the USPSTF. More information is available in the USPSTF Recommendation Statement and supporting documents on the USPSTF website (https://www.uspreventiveservicestaskforce.org). The practice recommendations in this activity are available at https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/carotid-artery-stenosis-screening.
This series is coordinated by Kenny Lin, MD, MPH, deputy editor.
A collection of Putting Prevention into Practice published in AFP is available at https://www.aafp.org/afp/ppip.
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