Carotid atherosclerosis is implicated in 20-30 % of strokes. However, the annual risk of stroke in patients with asymptomatic carotid stenosis is less than 5 %. Symptomatic carotid stenosis poses a greater risk for recurrent stroke with estimates as high as 15 % per year. This paper aims to raise awareness of populations at risk for carotid stenosis, the role of carotid screening and the sensitivity and specificity of various diagnostic modalities. The results of previous trials that support current guidelines for management of symptomatic and asymptomatic carotid stenosis will also be reviewed.

Stroke was missed more frequently when CPSS was not documented, in patients without motor signs, and in patients with moderate-severe stroke. The sensitivity of prehospital screening for patients with moderate-severe stroke might be improved by including additional non-motor signs and by stressing indications for when screens should be performed.