These manoeuvres are considered because stroke is one of the leading causes of death in Canada. The overall stroke mortality rate is 55 and 44 per 100,000 annually in men and women, respectively, and reaches 885 and 768 per 100,000 in elderly over 75 years of age. In Canada, about 50,000 new strokes occur each year and the estimated prevalence of stroke survivors is 208,000. Options Screening options are auscultation of neck bruits, duplex scanning, carotid Doppler ultrasonography, and magnetic resonance angiography. Medical management of asymptomatic carotid disease may include aspirin and antiplatelet agents.
Surgical management is by prophylactic carotid endarterectomy.
Outcomes Sensitivity and specificity for the screening tests, and death and stroke. Recommendations were not based on cost-effectiveness of options. Patient preferences were not discussed. Background papers providing critical appraisal of the evidence and tentative recommendations prepared by the chapter author were pre-circulated to the members. Consensus was reached on final recommendations.