Cost-Effectiveness of Screening for Asymptomatic Carotid Artery Stenosis Based on Atherosclerotic Cardiovascular Disease Risk Thresholds

Background Carotid artery stenosis (50-99% extracranial internal carotid artery narrowing) is a risk factor for ischemic stroke. However, no population-based studies have directly assessed the benefits and harms of screening for asymptomatic carotid artery stenosis (ACAS), and the CREST-2 trial is currently evaluating the efficacy of revascularization vs. intensive medical management for ACAS patients. Given this gap, the United States Preventive Services Task Force (USPSTF) currently recommends against screening for ACAS in the general population. Because ACAS prevalence and ischemic stroke risk vary by clinical risk factors, we sought to quantify the cost-effectiveness of screening for ACAS by cardiovascular disease risk-based sub-groups.