Role of carotid duplex imaging in carotid screening programmes - an overview

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Abstract

Background
Stroke is the most common cause of severe disability in the UK. Each year more than 110,000 people in England suffer from a stroke which costs the NHS over ÂŁ2.8 billion. Community-based vascular screening programs play a key role in early vascular disease detection and accurate diagnosis can potentially be cost-effective and in longer term, promote health and increase life expectancy.

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The main purpose to diagnose carotid artery disease is prevention of stroke in a high risk population. Common factors have been identified in multiple studies that successively characterize the risk of developing carotid artery stenosis in a selected population of patients. In a study by Jacobowitz et al. (2003) 1 the risk factors evaluated included smoking, hypertension, cardiac disease or hypercholesterolemia where altogether, increases the chances of developing cardiac stenosis by ├óÔÇ░─ä 50%. The absence of all these risk factors would reduce the incidence of cardiac stenosis to 1.8%. Consecutively, each risk factor would increase the chances of developing the incidence of disease by 5.8%, 13.5%, 16.7% and 66.7%1. Thus, statistically the probability of cardiac stenosis significantly increases with presence of risk factors. This would further isolate the group of patients that would benefit most, from this particular screening programme.

Methods
A Pub Med search was performed using keywords \carotid\", \"carotid artery disease\", \"carotid artery stenosis\", \"duplex\", \"ultrasound\" and \"screening\", to identify relevant published carotid screening studies which have used ultrasound as a screening tool. The search strategy is shown in the flow sheet (see additional file 1).

Results
6 studies were identified and included for overview (see additional file 2). Ballard et al2 suggested the effectiveness of community-based programmes in early vascular disease detection. They screened 1,719 patients by carotid ultrasound. The majority of carotid screens were normal; however, 28.9% (497 patients) had 15├óÔé¼ÔÇ£40% stenosis, 1.4% (24 patients) had 40├óÔé¼ÔÇ£60% stenosis, and 0.3% (six patients) had >60% stenosis. The benefit of screening on a large scale successively narrowed the group of patients that were susceptible to developing disease and led to many patients being referred for further testing and risk reduction programs before they developed significant disease.
 

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References
  1. Jacobowitz GR, Rockman CB, Gagne PJ, Adelman MA, Lamparello PJ, Landis R, Riles TS: A model for predicting occult carotid artery stenosis: screening is justified in a selected population. J Vasc Surg 2003, 38(4):705-9.
  2. Ballard JL, Mazeroll R, Weitzman R, Harward TR, Flanigan DP: Medical benefits of a peripheral vascular screening program. Ann Vasc Surg 2007, 21(2):159-62.
  3. Aboyans V, Lacroix P, Jeannicot A, Guilloux J, Bertin F, Laskar M: A new approach for the screening of carotid lesions: a 'fasttrack' method with the use of new generation hand-held ultrasound devices. Eur J Vasc Endovasc Surg 2004, 28(3):317-22.
  4. D'Agostino RS, Svensson LG, Neumann DJ, Balkhy HH, Williamson WA, Shahian DM: Screening carotid ultrasonography and risk factors for stroke in coronary artery surgery patients. Ann Thorac Surg 1996, 62(6):1714-23.
  5. Moore WS, Kempczinski RF, Nelson JJ, Toole JF: Recurrent carotid stenosis: results of the asymptomatic carotid atherosclerosis study. Stroke 1998, 29:2018-2025.
  6. Jotkowitz AB, Mark Clarfield A, Faust G, Wartman SA: Screening for carotid artery disease in the general public. Eur J InternMed 2005, 16(1):34-36.