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Wednesday
Feb212007

Should You Have a Carotid Artery Screen?

Atherosclerosis of the carotid arteries can lead to narrowing of the vessel (stenosis) and the risk of a plaque breaking off – both of which can precipitate a stroke or a transient ischemic attack (TIA). There’s scattered evidence that if one detects and treats narrowing (stenosis) early one can prevent a stroke from happening. But who should be screened for carotid stenosis? The American Society of Neuroimaging and the Society of Vascular and Interventional Neurology have now issued a guideline to answer this question. Importantly, the guideline gives weight to the expected benefits from treating a particular group of patients, based on the results of well-conducted, controlled clinical studies. The recommendations:

1. People over 65 with at least 3 of these cardiovascular risk factors: heredity, being male, advancing age, cigarette smoking, high blood pressure, diabetes, obesity (especially excess abdominal fat), lack of physical activity, and abnormal blood cholesterol.

2. Those scheduled for coronary artery bypass surgery who are 65 or older and have other risk factors – diabetes, peripheral vascular disease, smoking, cerebrovascular disease.

3. Patients with symptom-producing peripheral vascular disease

4. People who have had head and neck cancer treated by radiation therapy

5. Patients who have had carotid endarterectomy (removal of the atheromatous tissue) may have ultrasound screening on the other side from their operated side.

6. A history of retinal ischemic events (temporary blindness) without migraine or heart clot emboli.

Luckily, the health authorities in the USA have issued a recommendation to expand coverage for carotid artery stenting – an effective preventive procedure – to include those done inpatients with 50% stenosis or higher, or patients without symptoms but with 80% stenosis or higher. So, if you seem to be at risk at all, arrange for a screen – it shouldn’t be difficult.

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