Screening for asymptomatic carotid stenosis: routine or selective?

Stroke is one of the most serious health care conditions in the western world. In the USA nearly 800,000 strokes occur annually and in the EU more than 1.1 million strokes occur each year. It has been estimated that in the United States, 66,000 of 600,000 first-time strokes, and in the UK 16,500 of 150,000 new strokes annually, occur secondary to thromboembolism from extracranial carotid disease, and many of these strokes occur in individuals who were completely asymptomatic until that stroke occurred. A simple diagnostic test, Duplex ultrasound, can identify significant internal carotid stenoses in patients with asymptomatic disease. However, routine screening of individuals is controversial. This commentary will discuss the pros and cons of routine screening for asymptomatic carotid disease.