JAMA reiterates: There is no need - to prevent stroke, asymptomatic cervical artery stenosis screening does more harm than good!

Cervical artery stenosis is a recognized risk factor for stroke and a marker of cardiovascular disease.
, however, no population-based screening trials have been conducted for cervical arterial stenosis, so the best clinical treatment for asymptomatic cervical arterial stenosis remains uncertain.
current options are to use the best medication alone or in a joint use with angio reconstruction (endometriosis or cervical stent) to prevent stroke.
previous trials have shown that in-vasovascular therapy has less long-term benefits than using the best drug therapy alone, while also potentially resulting in additional surgical harm.
since 2007, the U.S. Preventive Services Task Force (USPSTF) has recommended class D evidence against screening for asymptomatic cervical artery stenosis in the general adult population.
USPSTF found that the average population had a lower risk of stroke due to asymptomatic cervical artery stenosis, while studies showed that surgery benefited less than medication, and there was also a mild and moderate risk of surgery.
, the working group's recommendations in 2014 again retained that view.
, the USPSTF conducted a summary analysis of the latest research evidence obtained after 2014 and published it in the latest JAMA journal.
consistent with the last two statements, the working group recommended that asymptomatic cervical arterial stenosis screening is not required for adults without stroke, neurological symptoms, or transient isothermic episodes.
is also in line with the recommendations of the American Heart Association (AHA)/American Stroke Association (ASA).
researchers conducted a literature search of controlled trials published in MEDLINE, PubMed, and Cochrane from January 1, 2014 to February 18, 2020.
two researchers independently evaluated articles that met the inclusion criteria and extracted and analyzed the data.
also reviews the latest comprehensive studies reported in each U.S. national database or surgical registry.
results screened 2,373 articles.
the inclusion criteria for the study did not show any evidence of the benefits or harms of direct screening for asymptomatic cervical stenosis.
only two limited, prematurely terminated trials reported a comparison between cervical arterial vascular reconstruction and optimal drug therapy and drug treatment alone, with different results.
, the results of the SPACE-2 trial (n s 316) showed no significant difference in the occurrence of stroke or death after one year compared to drug therapy, between endometriosis of the cervical artery (HR=2.82) or cervical arterial stent implantation (HR=3.50).
Another smaller AMTEC trial (n s 55) reported that the compound risk of non-lethal consetriction or death was significantly reduced in the cervical arterial endometriosis group at median follow-up of 3.3 years, and was statistically significant (HR s 0.20).
an editorial, Professor Larry Goldstein of the University of Kentucky said the current evidence supports the USPSTF's reaffirmation of screening recommendations for asymptomatic cervical arterial stenosis.
of stroke associated with asymptomatic cervical arterial stenosis is estimated at only 0.7 percent, significantly lower than other stroke risk factors.
researchers then analyzed the benefits and harms of cervical arterial screening.
In terms of benefits: 1) While there is ample evidence that Doppler ultrasound is sensitive and specific to testing for clinically relevant cervical arterial stenosis, false positive results may be produced when screened in the general population.
2) The accuracy of neck stethoscope of cervical artery murmurs is poor, and clinically related cervical artery stenosis cannot be detected.
there is not enough direct evidence that screening for asymptomatic cervical artery stenosis can reduce adverse health outcomes (e.g. stroke, mortality).
In terms of harm: 1) While there is not enough direct evidence to suggest that screening for asymptomatic cervical artery stenosis is harmful, treating asymptomatic patients with surgery or catheter-based treatment has little or no benefit in reducing adverse health outcomes compared to current treatment.
2) For diagnostic testing and interventions (e.g. computerized lithography, magnetic resonance imaging, invasive angiography, etc.) can cause additional harm.
, the overall risk of screening and treatment for asymptomatic cervical artery stenosis was mild and moderate, according to the USPSTF assessment.
addition, the USPSTF believes that screening for asymptomatic populations is more harmful than beneficial, and in this 2021 update, it was reiterated that no screening for asymptomatic people for cervical artery stenosis should be done.
: Guirguis-Blake JM, et al. Screening for Asymptomatic Carotid Artery Stenosis in the General Population: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2021 Feb 2; 325(5):487-489. doi: 10.1001/jama.2020.20364.MedSci Original Source: MedSci Original Copyright Notice: All notes on this website "Source: Met Medical" or "Source: MedSci Original" text, images and audio and video materials, copyrights are owned by Metz Medicine, without authorization, no media, website or individual may reproduce, authorized to reproduce with the words "Source: Mets Medicine".
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