ROLE OF DOPPLER US IN SCREENING FOR CAROTID ATHEROSCLEROTIC DISEASE

PURPOSE: To evaluate Doppler ultrasound (US) as a screening modality b efore arteriography for extracranial carotid artery disease. MATERIALS AND METHODS: The net benefit in stroke reduction from screening with Doppler US was calculated on the basis of literature estimates of dise ase prevalence, risk reduction data, and locally validated sensitiviti es and specificities for detection of carotid artery stenosis and occl usion in 215 patients. RESULTS: Screening a symptomatic population dem onstrated a net stroke reduction. Screening asymptomatic populations w ith a 20% prevalence of greater than or equal to 60% stenosis also yie lded a net stroke reduction. Screening low-prevalence (5%) asymptomati c populations produced a small benefit, which was lost if arteriograph ic or surgical complications increased slightly. Arteriographic confir mation of the US diagnosis of occlusion produced a small benefit only in the symptomatic population. CONCLUSION: Screening symptomatic and h igh-prevalence asymptomatic populations with US reduces stroke. Increa sed arteriographic or surgical complication rates reduce the benefit o f screening in any population.