Screening

Duplex ultrasonography is often used for identifying patients with asymptomatic carotid stenosis when clinically indicated.[14]​​[21]​ The low prevalence of asymptomatic carotid stenosis in the general population means that indiscriminate screening of all adults does not reduce the risk of stroke, and is not recommended.[2][14][22]​​​ Patients with risk factors may be considered for screening, but this is controversial. Society for Vascular Surgery guidelines suggest screening patients at increased risk of carotid stenosis, especially if they are willing to consider carotid intervention if significant stenosis is found.[14] European Society for Vascular Surgery guidelines recommend considering selective screening in patients with two or more risk factors, with the aim of optimising risk factor control and medical therapy.[2]​

The presence of a bruit is associated with carotid artery stenosis of any severity in 47% of patients; however, a clinically high-grade stenosis is found in only <2% of individuals with a bruit.[20] Therefore, indiscriminate imaging of all patients with a bruit has not generally been recommended by guidelines, although it may be considered if there are other associated risk factors for stenosis.[14] 

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