In July 2014, the U.S. Preventive Services Task Force (USPSTF) published a clinical guideline on screening for asymptomatic carotid artery stenosis. The guideline recommended against screening in asymptomatic adults, based primarily on the results of 3 large randomized trials (grade D recommendation). The principal screening test was carotid ultrasonography, and the intervention in the 3 trials was carotid endarterectomy for patients with stenosis exceeding 50% to 60%. In a meta-analysis, carotid endarterectomy reduced rates of 1) perioperative stroke, death, or subsequent ipsilateral stroke and 2) perioperative stroke, death, or any subsequent stroke. The corresponding absolute risk differences were –2.0% (95% CI, –3.3% to –0.7%) and –3.5% (CI, –5.1% to –1.8%), respectively. However, perioperative stroke and death were substantially less common among the 3 randomized trials than in contemporaneous cohort studies (1.9% vs. 3.3%). In addition to stroke or death in patients receiving carotid endarterectomy, a harm of screening included the risk for angiography prompted by abnormal results on carotid ultrasonography. In this article, 2 discussants address the risks and benefits of screening for carotid artery disease as well as how to apply the guideline to an individual patient who is deciding whether to be screened.

2014年7月，美国预防服务工作队（USPSTF）发布了筛查无症状性颈动脉狭窄的临床指南。该指南主要针对3个大型随机试验的结果（建议D级），建议不要在无症状的成年人中进行筛查。主要的筛查测试是颈动脉超声检查，在3个试验中的干预是对狭窄超过50％至60％的患者进行颈动脉内膜切除术。在荟萃分析中，颈动脉内膜切除术降低了以下比率：1）围手术期中风，死亡或随后的同侧中风； 2）围手术期中风，死亡或任何随后的中风。相应的绝对风险差异分别为–2.0％（95％CI，–3.3％至–0.7％）和–3.5％（CI，–5.1％至–1.8％）。然而，3项随机试验中，围手术期卒中和死亡的发生率远低于同期同期队列研究（1.9％vs. 3.3％）。除接受颈动脉内膜切除术的患者中风或死亡外，筛查的危害还包括由于颈动脉超声检查结果异常而引起血管造影的风险。在这篇文章中，有2位讨论者讨论了筛查颈动脉疾病的风险和收益，以及如何将指南应用于正在决定是否进行筛查的个体患者。