In asymptomatic carotid artery disease, what is recommended regarding screening for stroke risk?

• A. Screen ultrasound for all asymptomatic individuals
• B. Screen only after a TIA
• C. Screen only if high risk
• D. No screening despite risk factor

Answer: (D)

Screening people who have no symptoms for carotid artery disease does not reduce stroke risk and can cause more harm than good. Carotid ultrasound in asymptomatic individuals often yields false positives and leads to unnecessary testing, anxiety, referrals, and potentially invasive procedures with their own risks, including perioperative stroke or death. The prudent approach is to focus on managing overall vascular risk factors—control blood pressure, lipids, and diabetes, promote smoking cessation, and use antiplatelet therapy when indicated—while reserving carotid imaging for those who develop symptoms (such as a TIA or stroke) or for specific situations where knowing carotid status would change management. Therefore, routine screening is not recommended despite risk factors.