Document Detail


Assessment of the efficacy of noninvasive screening for patients with asymptomatic neck bruits.
MedLine Citation:
PMID:  9227679     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: Several recent clinical trials have shown that endarterectomy is efficacious in patients with asymptomatic carotid artery stenosis. The purpose of this study was to evaluate the effectiveness of various test strategies for screening and diagnosing carotid artery disease. METHODS: We constructed a model of the natural history of carotid artery disease using literature-based estimates of the prevalence and incidence of carotid artery stenosis and associated morbidity and mortality. Markov cohort simulation was used to estimate the mean quality-adjusted life years and monetary costs associated with various management strategies. RESULTS: Screening is cost-effective in the baseline model. Key parameters affecting the efficacy of screening are prevalence of operable lesions, benefit of surgery, surgical complication rates, quality of life with stroke, rate of stenosis progression, and excess morbidity and mortality. CONCLUSIONS: Asymptomatic patients with carotid bruits may benefit from screening if the prevalence rate is > or = 20%, the benefits and risks associated with surgery are similar to those observed in the Asymptomatic Carotid Atherosclerosis Study, and the quality of life with stroke is considerably lower than the quality of life without stroke. Ultrasound followed by three-dimensional time-of-flight MR angiography, if indicated, is a promising test strategy.
Authors:
N A Obuchowski; M T Modic; M Magdinec; T J Masaryk
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  28     ISSN:  0039-2499     ISO Abbreviation:  Stroke     Publication Date:  1997 Jul 
Date Detail:
Created Date:  1997-08-25     Completed Date:  1997-08-25     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1330-9     Citation Subset:  IM    
Affiliation:
Department of Biostatistics and Epidemiology, Cleveland Clinic Foundation, Ohio 44195, USA. nobuchow@bio.ri.ccf.org
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MeSH Terms
Descriptor/Qualifier:
Carotid Stenosis / complications,  epidemiology,  ultrasonography*
Case Management
Cerebrovascular Disorders / etiology,  prevention & control
Cohort Studies
Cost-Benefit Analysis
Decision Trees
Humans
Magnetic Resonance Angiography* / economics
Mass Screening / methods*
Neck
Prevalence
Risk Assessment
Sensitivity and Specificity
Ultrasonography, Doppler* / economics
Grant Support
ID/Acronym/Agency:
2-RO1-HL43812-04/HL/NHLBI NIH HHS
Comments/Corrections
Comment In:
Stroke. 1999 Oct;30(10):2247-8   [PMID:  10512994 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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