1. Imaging of the cervical carotid artery is recommended in all patients with symptoms of carotid territory ischemia. This recommendation is based on the significant incidence of clinically relevant carotid stenosis in this patient group and the efficacy of carotid endarterectomy (CEA) for clinically significant lesions in reducing overall stroke (Grade 1, Level A).
2. Imaging should be strongly considered for patients who present with amaurosis fugax, evidence of retinal artery embolization on fundoscopic examination, or asymptomatic cerebral infarction and are candidates for CEA. This recommendation is based on the intermediate stroke risk in this group of patients and the efficacy of CEA in reducing risk of subsequent stroke (Grade 1, Level A).
3. Routine screening is not recommended to detect clinically asymptomatic carotid stenosis in the general population. Screening is not recommended for presence of a neck bruit alone without other risk factors. This recommendation is based on the low prevalence of disease in the population at large, including those with neck bruits, as well as the potential harm of indiscriminate application of carotid bifurcation intervention to a large number of asymptomatic individuals (Grade 1, Level A).
4. Screening for asymptomatic clinically significant carotid bifurcation stenosis should be considered in certain groups of patients with multiple risk factors that increase the incidence of disease as long as the patients are fit for and willing to consider carotid intervention if a significant stenosis is discovered. The presence of a carotid bruit in these patients increases the likelihood of a significant stenosis (Grade 1, Level B).
   
   Such groups of patients include:
   1. Patients with evidence of clinically significant peripheral vascular disease regardless of age.
   2. Patients 65 years or older with a history of one or more of the following atherosclerotic risk factors: coronary artery disease, smoking, or hypercholesterolemia. In general, the more risk factors present, the higher the yield of screening should be expected.
5. Carotid screening may be considered in patients prior to coronary artery bypass. This is most likely to be fruitful if the patients are greater than 65, have left main disease or a history of peripheral vascular disease. The strongest indication for screening these patients from the data available is to identify patients at high risk for perioperative stroke. (Grade 2, Level B)
6. Carotid screening is not recommended for patients with abdominal aortic aneurysm (AAA) who do not fit into one of the above categories (Grade 2, Level B).
7. Carotid screening is not recommended for asymptomatic patients who have undergone prior head and neck radiation. While the incidence of disease is increased in this group of patients, the utility of intervention in the absence of neurologic symptoms has not been clearly established (Grade 2, Level B).