Please note: In 2003, the CTF updated its Grades of Recommendations to include an "I Recommendation" for situations where insufficient evidence exists to allow a recommendation to be made. (Formerly, these situations were captured under a "C Recommendation".) This change is not retroactive, and all "C Recommendations" made prior to 2003 have not been reevaluated in light of the new "I" recommendation grade. For a discussion of these recommendation grades, please link to the 2003 article in the Canadian Medical Association Journal here.
| MANEUVER | EFFECTIVENESS | LEVEL OF EVIDENCE <REF> | RECOMMENDATION |
| Neck auscultation | Insensitive and non-specific marker for underlying carotid stenosis. Positive predictive value ranging from 16-75%. | Descriptive studies <14-20> (III) | Fair evidence not to include in periodic health examination of asymptomatic individuals. (D) |
| Medical therapy | No actual evidence for effectiveness of ineffectiveness of medical therapy (antiplatelets) in patients with asymptomatic carotid bruit or stenosis. | One controlled randomized trial in progress <24> (II-2) | Insufficient evidence to include or exclude in treatment of those with asymptomatic carotid disease. (C) |
| Carotid endarterectomy (CE) | Presently, evidence is not conclusive regarding preventive effect of CE on occurrence of fatal and non-fatal stroke in asymptomatic individuals with carotid stenosis but CE is associated with severe morbidity of mortality of 1-4.5%. | Randomized controlled trials <26-28> (I) | Fair evidence not to use carotid endarterectomy to treat those with asymptomatic carotid stenosis. (D) |
Link to Full Text of this review
Link to Structured Abstract of this review
Link to Selected References list of this review
Reprinted in modified format by the Canadian
Task Force on Preventive Health Care
with permission.
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© 1994 Minister of Supply and Services Canada.
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Last modified March 27, 1998.
