Hosp Pract (1995). 2022 Nov 3. doi: 10.1080/21548331.2022.2144066. Online ahead of print.
ABSTRACT
OBJECTIVES: In the United States, approximately 18-25 percent of carotid duplex ultrasound (CUS) studies are ordered to assess patients with non-lateralizing neurological complaints such as syncope, blurry vision, lightheadedness, headache, and altered mental status. The purpose of this study is to evaluate the benefit of CUS in the evaluation of patients presenting with non-lateralizing signs or symptoms.
MATERIALS AND METHODS: We conducted a retrospective analysis to assess the degree and laterality of carotid stenosis among patients with non-lateralizing neurological complaints who underwent CUS interpreted by certified vascular neurologists over a period of three years. The primary endpoint was to identify the prevalence of moderate to severe carotid artery stenosis among 280 patients who met inclusion criteria.
RESULTS: 17.7% of CUS studies were ordered for non-lateralizing symptoms. 261 patients (93.21%) had either normal imaging or mild carotid stenosis of <50%. 19 patients (6.79%) were found to have stenosis of ≥50%. In this subgroup, age and known pre-existing carotid artery atherosclerotic disease were the only variables found to have a statistically significant association with the level of stenosis found on CUS. Two patients with asymptomatic stenosis of >70% underwent a revascularization procedure.
CONCLUSION: At least 17.7% of CUS studies were completed for non-lateralizing symptoms. The study is of low-yield with the prevalence of moderate to severe stenosis being comparable to that in the general asymptomatic population. We conclude that there is minimal clinical value in the use of CUS to investigate non-lateralizing neurological complaints, resulting in unnecessary healthcare costs.
PMID:36325737 | DOI:10.1080/21548331.2022.2144066
