Background: Asymptomatic carotid artery disease should be treated as soon as possible before the atherosclerotic disease progressed into ischaemic stroke. Diagnostic screening by measuring intima-media thickness (IMT) of carotid artery using ultrasound is one possible way to evaluate earlier the progression compared to standard stenosis evaluation. Not only the necessity of carotid screening is still questioned by some experts, current guidelines also show conflicting results in certainty whether we should perform the carotid screening or not. It is necessary to conduct a literature review of relevant recommendations from the latest clinical practice guidelines (CPGs). Method: The CPGs on the management of asymptomatic carotid artery disease published before October 2020 were retrieved from online databases and the rigor of guideline development assesed by using the Appraisal of Guidelines Research and Evaluation II (AGREE-II) instrument. The quality of CPGs was assessed and categorized, and their reported evidences were also evaluated. Results: Six eligible CPGs were included. Five of the CPGs recommends carotid screening for highly selective patient who has morbidity regarding atherosclerotic disease manifested in other organs. One CPG against the screening as further treatment considered cause more harms, although the recommendations mainly based on hypothetical outcomes and the CPG itself categorized into moderate quality. Conclusion: Our critical review on those CPGs showed that screening for asymptomatic carotid artery disease should be performed for specific high-risk populations of atherosclerotic disease. Although IMT evaluation could be a promising technique, current guidelines didn’t show any recommendation regarding the usage comparing standard ultrasound evaluation.

Introduction Carotid artery disease in geriatric is one of the important etiologies of stroke, which topped the cause of mortality in Indonesia. Specific prevention should be done as early as asymptomatic disease occurred. Initial assessment can be performed using ultrasound by measuring the intima-media thickness (IMT) of carotid artery, which can evaluate earlier progression of the atherosclerosis process. Unfortunately, we do not have risk factors categorization that show us which geriatric population fall under high-risk stratification to be screened. Method Study was done to Indonesian geriatric population. Asymptomatic carotid disease was tested positive if IMT was > 0.9 mm without any previous neurological symptoms. Correlation of the result was statistically tested with risk factors of atherosclerotic process, such as sex, body mass index, presence of hypertension, diabetes mellitus, and hypercholesterolemia Results Study obtained 104 subjects and showed the prevalence of asymptomatic carotid disease was 37.5%. Two risk factors: diabetes mellitus and hypercholesterolemia were statistically significant (p = 0.01) with odds ratio (OR) 3.56 (1.31–9.64, 95% confidence interval [CI]) and OR 2.85 (1.25–6.51, CI 95%), respectively. Logistic regression showed the risk was 69.2% by having two of these comorbidities, 47.2 or 42.5% if diabetes mellitus or hypercholesterolemia was present. Conclusion As diabetes mellitus and hypercholesterolemia were proved to be significant risk factors for asymptomatic carotid artery disease, we recommend performing ultrasound screening to measure carotid artery IMT for geriatric population who had diabetes mellitus and/or hypercholesterolemia for asymptomatic carotid artery disease to be diagnosed and further treated.