Carotid Ultrasound (Intima-Media Thickness / Plaque)
Ultrasound assessment of carotid artery wall thickness and any plaque, frequently marketed as a “vascular age” or stroke-risk test. Carotid plaque does reflect systemic atherosclerosis, and high-grade stenosis can directly cause stroke — which is what makes the sales pitch plausible and the guideline position worth reading carefully.
The US Preventive Services Task Force gives screening for asymptomatic carotid artery stenosis a “D” recommendation — that is, actively against it — with moderate certainty that the harms outweigh the benefits. Those harms are unnecessary downstream imaging and procedures arising from false positives, plus procedural complications from unindicated intervention. No externally validated method reliably identifies which asymptomatic adults are genuinely at increased stroke risk from an incidental carotid finding.
USPSTF Recommendation Statement, JAMA 2021. PubMed: PMID 34058106