The following study states that The USPSTF based their recommendation regarding asymptomatic carotid disease on several conclusions that I would challenge. (1) There are no externally validated methods to determine who is at increased risk for carotid artery stenosis or associated stroke. (2) There are no studies that directly examined the health benefits of screening with duplex ultrasound (DUS) examination. The American Heart Association and the American Stroke Association agreed with this position and jointly recommend against routine screening for carotid artery stenosis in asymptomatic patients using DUS examination. (3) The harm associated with carotid intervention, such as carotid endarterectomy (CEA) or stenting, outweighs the benefits.

The USPSTF bases their conclusions regarding CEA on three randomized trials and states that none of the trials focused on exclusively asymptomatic populations, because some trial patients reported a history of contralateral artery transient ischemic attack, stroke, or CEA at baseline. They also criticize the findings of the trials because (1) medical therapy varied by trial and may not have reflected contemporary aggressive risk factor modification and (2) operators were highly selected based on their low morbidity and mortality rates. Regarding stenting, the USPSTF stated that risks of transcarotid artery revascularization (TCAR) outweigh the benefits because they “did not find any studies that examined the benefits and harms of TCAR.

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