Screening Recommendations for Asymptomatic Carotid Artery Disease and Role of Carotid Intima-Media Thickness Evaluation: A Literature Review

Abstract

Background: Asymptomatic carotid artery disease should be treated as soon as possible before the atherosclerotic disease progressed into ischaemic stroke. Diagnostic screening by measuring intima-media thickness (IMT) of carotid artery using ultrasound is one possible way to evaluate earlier the progression compared to standard stenosis evaluation. Not only the necessity of carotid screening is still questioned by some experts, current guidelines also show conflicting results in certainty whether we should perform the carotid screening or not. It is necessary to conduct a literature review of relevant recommendations from the latest clinical practice guidelines (CPGs). Method: The CPGs on the management of asymptomatic carotid artery disease published before October 2020 were retrieved from online databases and the rigor of guideline development assesed by using the Appraisal of Guidelines Research and Evaluation II (AGREE-II) instrument. The quality of CPGs was assessed and categorized, and their reported evidences were also evaluated. Results: Six eligible CPGs were included. Five of the CPGs recommends carotid screening for highly selective patient who has morbidity regarding atherosclerotic disease manifested in other organs. One CPG against the screening as further treatment considered cause more harms, although the recommendations mainly based on hypothetical outcomes and the CPG itself categorized into moderate quality. Conclusion: Our critical review on those CPGs showed that screening for asymptomatic carotid artery disease should be performed for specific high-risk populations of atherosclerotic disease. Although IMT evaluation could be a promising technique, current guidelines didn’t show any recommendation regarding the usage comparing standard ultrasound evaluation.