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Symptoms, stenosis, and bruit: interrelationships in carotid artery disease
Insights
This study found a strong link between carotid artery stenosis severity and neurological symptoms. However, the presence of a cervical bruit did not consistently correlate with symptoms, advising against delaying workups.
Area of Science:
- Vascular Neurology
- Cerebrovascular Disease
Background:
- Carotid artery stenosis is a significant risk factor for stroke.
- Cervical bruits are often used as a clinical sign of carotid artery disease.
Purpose of the Study:
- To investigate the relationship between the degree of carotid artery stenosis, focal neurologic symptoms, and the presence of cervical bruits.
- To determine the diagnostic value of cervical bruits in identifying symptomatic carotid artery stenosis.
Main Methods:
- Analysis of 990 carotid arteries from 495 patients.
- Correlation of stenosis degree with reported focal neurologic symptoms.
- Assessment of the association between stenosis and the presence of cervical bruits.
Main Results:
- A linear relationship was observed between increasing carotid artery stenosis and the likelihood of focal neurologic symptoms.
- Highly stenotic (80-99%) and occluded vessels showed high rates of symptomatic presentation (72% and 82%, respectively).
- Cervical bruit presence correlated with stenosis degree up to, but not including, total occlusion; 53% of symptomatic arteries had a bruit, while 47% did not.
Conclusions:
- The degree of carotid artery stenosis is a reliable predictor of focal neurologic symptoms.
- The absence of a cervical bruit in patients with suspected extracranial vascular disease should not preclude further diagnostic workup.
- Cervical auscultation alone is insufficient to rule out significant carotid artery stenosis causing neurologic deficits.
Abstract:
The relationship between focal neurologic symptoms, carotid artery stenosis, and cervical bruits was studied in 495 patients. Among the 990 carotid arteries, 562 (57%) were considered to be symptomatic and 505 (51%) were associated with bruit. There was a linear relationship between the degree of stenosis and symptoms. Of the highly stenotic vessels (80% to 99% narrowing), 253 of 350 (72%) were symptomatic; 85 of 104 (82%) occluded vessels were symptomatic. There was a linear relationship between the occurrence of cervical bruit and degree of stenosis, up to but not including total occlusion. The relationship between bruits and focal neurologic symptoms was less direct. Among 562 symptomatic arteries, 297 (53%) had a bruit and 265 (47%) did not. In symptomatic patients, the absence of a cervical bruit should not delay a workup for extracranial vascular disease.