Strokes and the carotid: myths and realities

Cervical bruits in asymptomatic individuals identify persons at increased risk of future stroke and at even higher risk of ischemic heart disease. Strokes in these patients rarely occur in the same vascular distribution as the bruit. In prospective studies, an asymptomatic bruit does not identify patients at higher risk of perioperative stroke even in patients undergoing coronary bypass or other major vascular surgery. When a stroke occurs in the perioperative setting, it is much more likely due to embolism from the cross-clamped aorta or extraneous material from the bypass machine than from hypoperfusion of, or embolism from, the carotid arteries.