Who should be screened for asymptomatic carotid artery stenosis? Experience from the Western New York Stroke Screening Program

Adnan I. Qureshi, Vallabh Janardhan, Susan E. Bennett, Andreas R. Luft, L. Nelson Hopkins, Lee R. Guterman

Research output: Contribution to journalArticle

43 Scopus citations

Abstract

Objective. Identification of significant asymptomatic carotid artery stenosis (ACAS) is important because of the stroke-risk reduction observed with carotid endarterectomy. The authors developed and validated a simple scoring system based on routinely available information to identify persons at high risk for ACAS using data collected during a community health screening program at various sites in western New York. A total of 1331 unselected volunteers without previous stroke, transient ischemic attack, or carotid artery surgery were evaluated by personal interview and duplex ultrasound. The main outcome measure was carotid artery stenosis >60% by duplex ultrasound. In the derivation set (n = 887), 4 variables were significantly associated with ACAS >60%: age >65 years (odds ratio [OR] = 4.1, 95% confidence interval [Cl] = 2.6-6.7), current smoking (OR = 2.0, 95% Cl = 1.2-3.5), coronary artery disease (OR = 2.4, 95% Cl = 1.5-3.9), and hypercholesterolemia (OR = 1.9, 95% Cl = 1.2-2.9). Three risk groups (low, intermediate, and high) were defined on the basis of total risk score assigned on the basis of the strength of association. The scheme effectively stratified the validation set (n = 444); the likelihood ratio and posttest probability for ACAS in the high-risk group were 3.0 and 35%, respectively, and in the intermediate and low-risk groups were 1.4 and 20% and 0.4 and 7%, respectively. Routinely available information can be used to identify persons in the community at high risk for ACAS. Doppler ultrasound screening in this subgroup may prove to be cost-effective and have an effect on stroke-free survival.

Original languageEnglish (US)
Pages (from-to)105-111
Number of pages7
JournalJournal of Neuroimaging
Volume11
Issue number2
DOIs
StatePublished - Jan 1 2001

Keywords

  • Carotid artery stenosis
  • Cigarette smoking
  • Doppler ultrasound
  • Hypertension
  • Prevalence
  • Receiver operating characteristic analysis
  • Risk factors
  • Screening

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