The recently released 2024 European Society of Cardiology (ESC) guidelines recognised that due to the low prevalence of >70% asymptomatic carotid stenosis (AsxCS) in the general population, as well as due to the lack of evidence that screening reduces stroke risk, widespread population-wide screening should not be recommended.

On the other hand, it was supported that screening for significant AsxCS in specific, highly-selected populations might be effective, especially if the prevalence of AsxCS is >20%. These populations include hemodialysis patients, individuals with peripheral arterial or severe coronary artery disease, a carotid bruit, etc.

It was argued that when the degree of AsxCS is >70%, the 5-year ipsilateral stroke risk is nearly 15%, and therefore revascularisation may be beneficial. The rationale supporting selective screening for AsxCS is to optimize risk factor control and to initiate intensive medical therapy, rather than to select candidates for a carotid revascularisation procedure.

This view was upheld by the 2023 ESC Council on Stroke Consensus Document, as well as by the 2024 ESC Guidelines, and may promote the initiation of such selective screening programmes.