Q Do carotid artery calcifications seen on radiographs predict stenosis in asymptomatic adults?
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Evidence-based answer: not very well. In asymptomatic patients, carotid artery calcification seen on radiograph has a positive predictive value of 70% and a negative predictive value of 75% for carotid artery stenosis (strength of recommendation [SOR]: B, systematic review of observational studies with heterogeneous results and a retrospective cohort study). Carotid calcifications on radiographs may be more predictive of carotid stenosis in people with atherosclerotic risk factors (SOR: C, cross-sectional study). Harms outweigh benefits in screening for carotid artery stenosis in asymptomatic adults (SOR: B, multiple cohort studies); therefore, incidental radiographic carotid artery calcifications in asymptomatic patients should not prompt further testing
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