Clinical sequelae in patients with asymptomatic carotid bruits

Noninvasive vascular laboratory evaluations were performed on 163 patients who presented with asymptomatic carotid bruits. Of these, 57 patients were identified as having a solely transmitted murmur. The remaining 106 patients had carotid disease. Based on hemodynamic criteria, 77 patients had compensated disease and 29 had uncompensated disease. These patients were followed for from 1 to 56 months (mean 31). Patients in the uncompensated group developed symptoms attributable to the extracranial territory at a higher rate than did patients in the compensated group, with differences continuing for 36 months. At 18 months the accumulated symptom rate for the uncompensated group (24.0%) was over twice that for the compensated group (11.4%). Patients in the uncompensated group also had a higher mortality rate. Differences occurred after 12 months and continued through 36 months. Of the 23 patients who died, 19 (82%) died due to cardiac disease, two due to cerebrovascular accidents, and two due to neoplastic disease. In view of the results of this study, a careful examination of patients with asymptomatic cervical bruits is warranted. This evaluation should take the form of a noninvasive vascular laboratory evaluation, which can help determine the proper course of patient management by measuring functional deficit and estimating anatomic severity.