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Background and purpose In the discussion on the cost-effectiveness of screening precise estimates of severe asymptomatic carotid stenosis (ACAS) are vital. Accordingly, we assessed the prevalence of moderate and severe ACAS by age and sex using pooled cohort data. Methods We performed an individual participant data meta-analysis (23,706 participants) of four population-based studies (MDCS, Tromsø, CAPS and CHS). Outcomes of interest were asymptomatic moderate (≥50%) and severe carotid stenosis (≥70%). Results Prevalence of moderate ACAS ranged from 0.5% (95% CI, 0.3% to 1.1%) in men aged below 50 years to 5.7% (4.5% to 7.1%) in men aged 80 years and above. For women this prevalence increased from 0.3 (0.1% to 0.6%) to 4.5% (2.8% to 6.8%). Prevalence of severe ACAS ranged from 0.1% (0.0% to 0.4%) in men aged below 50 years to 1.7% (0.8% to 3.4%) in men aged 80 and above. For women this prevalence increased from zero (0.0% to 0.2%) to 0.9% (0.4% to 2.4%). Conclusions Prevalence of severe ACAS in the general population ranges from zero to 1.6% which is useful information in the discussion on the cost-effectiveness of screening.

The ELAPSS score consists of 6 easily retrievable predictors and can help physicians in decision making on the need for and timing of follow-up imaging in patients with unruptured intracranial aneurysms.