Screening for asymptomatic carotid stenosis in patients with non-valvular atrial fibrillation

Abstract

Jolobe supports that screening for asymptomatic carotid stenosis (AsxCS) should be extended to patients with non-valvular atrial fibrillation (NVAF). Indeed, a 2021 meta-analysis (n = 20 studies; 49,070 patients) demonstrated that the pooled prevalence of >50% AsxCS inpatients with NVAF was 12.4% (range: 4.4–24.3%). Although this issue was not discussed in our manuscript, the optimal management of patients presenting with a recent transient ischemic attack [TIA]/ischemic stroke with an ipsilateral 50–99% carotid stenosis and concomitant NVAF was addressed by the 2023 European Society for Vascular Surgery (ESVS) carotid guidelines. It was recognized that although no guidelines have provided recommendations regarding the management of these patients, a pragmatic approach is warranted.