Draft Research Plan
Draft Research Plan for Asymptomatic Carotid Artery Stenosis: Screening
This opportunity for public comment expired on September 11, 2019 at 8:00 PM EST
Note: This is a Draft Research Plan. This draft is distributed solely for the purpose of receiving public input. It has not been disseminated otherwise by the USPSTF. The final Research Plan will be used to guide a systematic review of the evidence by researchers at an Evidence-based Practice Center. The resulting Evidence Review will form the basis of the USPSTF Recommendation Statement on this topic.
Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
Draft: Proposed Key Questions to Be Systematically Reviewed
- Is there direct evidence that screening asymptomatic adults for carotid artery stenosis (CAS) with duplex ultrasonography improves health outcomes?
- What are the harms associated with screening or confirmatory testing for asymptomatic CAS?
- For asymptomatic persons with CAS, does treatment with carotid endarterectomy (CEA) or carotid angioplasty and stenting (CAAS) provide incremental benefit beyond current standard medical therapy?
- What are the harms associated with CEA or CAAS for the treatment of asymptomatic CAS?
Draft: Proposed Research Approach
The Research Approach identifies the study characteristics and criteria that the Evidence-based Practice Center will use to search for publications and to determine whether identified studies should be included or excluded from the Evidence Review. Criteria are overarching as well as specific to each of the key questions (KQs). The update for this topic will be conducted using rapid synthesis procedures, as described in Section 4.7 of the USPSTF Procedure Manual (available at https://www.uspreventiveservicestaskforce.org/Page/Name/methods-and-processes).
|Populations||KQs 1, 2: Unselected or community-dwelling, generally asymptomatic adults (i.e., without neurologic symptoms referable to the carotid artery or a history of a stroke or transient ischemic attack)
KQs 3, 4: Unselected or community-dwelling, generally asymptomatic adults with clinically important CAS (defined as 60% to 99% stenosis)
|All KQs: Children and adolescents; symptomatic adults with CAS; adults with history of stroke or transient ischemic attacks
KQs 1, 2: Persons with known carotid occlusion; with known CVD; who are undergoing CAS testing for preoperative planning; or have had CEA or CAAS and are undergoing surveillance for restenosis
|Interventions||KQs 1, 2: Screening with carotid duplex ultrasonography
KQs 3, 4: CEA, CAAS
|KQs 1, 2: Physical examination for carotid bruit; carotid intima-media thickness test for CVD risk prediction|
|Comparisons||KQs 1, 2: No screening
KQ 3: Medical treatment/usual care (e.g., statins, antiplatelet medications)
KQ 4: Medical treatment/usual care or noncomparative studies reporting rates of harms
|KQs 3, 4: Comparative studies of CEA vs. CAAS|
|Outcomes||KQs 1, 3: CAS-related stroke, mortality, quality of life, functional status
KQ 2: Adverse outcomes related to screening tests or subsequent confirmatory testing (i.e., angiography)KQ 4: Perioperative complications (e.g., stroke, mortality, myocardial infarction, cranial nerve injuries)
|KQs 1, 2: Diagnostic accuracy, CVD risk prediction|
|Study designs||KQs 1–3: Randomized, controlled trials
KQ 4: Randomized, controlled trials; large cohort studies or registries
|All KQs: Cost-effectiveness analyses
KQs 1–3: All designs other than randomized, controlled trialsKQ 4: Case reports, small observational studies
|Countries||Studies conducted in countries categorized as “very high” on the Human Development Index (as defined by the United Nations Development Programme)|
|Language||English only||Non-English languages|
|Years||2014 to present||Publications prior to 2014|
Abbreviations: CAAS=carotid angioplasty and stenting; CAS=carotid artery stenosis; CEA=carotid endarterectomy; CVD=cardiovascular disease; KQ=key question.
Internet Citation: Draft Research Plan: Asymptomatic Carotid Artery Stenosis: Screening. U.S. Preventive Services Task Force. August 2019.