[Carotid bruit: what should be done? Color duplex ultrasound indicates if operation is necessary]

Carotid bruits need to be investigated without delay. The best imaging procedure available is color-coded duplex ultrasonography in the hands of an experienced examiner. Intra-arterial digital subtraction angiography should be used only when a surgical option appears indicated and the surgeon requests it prior to the operation. Determination of the intima/media thickness with the aid of the B scan provides good prognostic information. In the case of higher-grade stenoses with corresponding symptomatology, carotid surgery is indicated. Before carrying out such operations, however, the patient's risk and the surgery-related risk of a stroke or some other event occurring must be carefully weighed, one against the other, with the results achieved by the surgeon in this area being a major factor.