Preventing thousands of strokes per year through quick carotid ultrasound screening

Screening all Americans aged 65 and older with a quick, one-minute carotid ultrasound test could help prevent thousands of strokes per year, says an article published in the Annals of Translational Medicine.

The authors say that a one-minute ultrasound screening test can flag those suspected of having plaque in their carotid arteries causing at least 50% blockage. The carotid arteries carry blood to the brain, and if there is plaque in those arteries and the plaque ruptures, a stroke can result.

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For those whose screening test indicates possible substantial blockage, a follow-up “formal” duplex ultrasound test can identify those who indeed have 50% blockage of one or both carotid arteries, the authors say. Those individuals could then protect their arteries and stabilize the plaque, the authors say, by electing either vascular surgery or best medical treatment, with the latter presumably including statin therapy.

A quick carotid scan has been used for many years, the authors say, to screen military retirees at the Madigan Army Medical Center in Tacoma, Washington, and has also been used at New York University.

The authors estimate that their proposed screening and follow-up process would find the estimated 8% of Americans aged 65 and older who, according to their research, have carotid artery blockage of at least 50%. These individuals typically would have had no symptoms, and thus no idea that their arteries were partially blocked. Subsequent treatment could reduce the 5-year risk of stroke for these individuals from 20% if left untreated, to less than 3%, they say.

That would prevent 200,000 strokes and yield one-time Medicare savings of $13 billion from avoided direct medical costs, according to earlier research the article cites, which was led by the same principal investigator.

The authors note that stroke is also the leading long-term Medicare expenditure, “fills one-half of nursing homes,” and “has persisted without reduction for decades,” even though the Centers for Disease Control and Prevention says that 80% of strokes could be prevented.

While Medicare in the U.S. does not cover the cost of carotid screening, “it does reimburse for the further evaluation and management of disease found on screening,” the authors say, “which can cover the nominal monetary outlay of a medical facility to provide the initial screening.”

The authors add that at the time of a quick carotid scan, “there is the option of including an ultrasound scan of the abdominal aorta to discover aortic aneurysms prior to rupture, and of scanning the common femoral artery to identify arteriosclerotic plaques which have a high correlation with coronary artery disease and can be a trigger for a cardiac and metabolic evaluation.”

The study, available online for free, is titled “The quick carotid scan for prevention of strokes due to carotid artery disease.”

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