Related Experiment Videos
Do carotid bruits predict disease of the internal carotid arteries?
1Walton Centre for Neurology and Neurosurgery, Liverpool, UK.
Insights
A carotid bruit is an unreliable indicator of carotid artery disease. Patients with suspected stroke symptoms should be referred for evaluation regardless of bruit presence to ensure timely diagnosis and treatment.
Area of Science:
- Vascular Surgery
- Neurology
- Diagnostic Imaging
Background:
- Carotid bruits are traditionally considered indicative of extracranial carotid artery disease.
- Carotid endarterectomy is a proven intervention for symptomatic carotid artery stenosis.
- Accurate detection of significant carotid stenosis is crucial for patient management.
Purpose of the Study:
- To evaluate the diagnostic value of a carotid bruit in predicting significant carotid artery stenosis.
- To assess the utility of a carotid bruit in patient referral for cerebrovascular assessment.
Main Methods:
- Prospective study of 331 consecutive patients referred to a cerebrovascular clinic.
- Clinical assessment, risk factor evaluation, and Doppler duplex scanning of carotid arteries were performed.
- Data analysis focused on the correlation between the presence of a carotid bruit and the severity of carotid stenosis.
Main Results:
- A carotid bruit was present in 33% of referred patients.
- Moderate to severe carotid stenosis (30-99%) was found in 37% of patients with a bruit versus 17% without (P < 0.001).
- The positive predictive value of a carotid bruit for significant stenosis was low (37%), with a high false-negative rate (43%) for severe disease.
Conclusions:
- A carotid bruit is a poor predictor of significant extracranial carotid artery disease.
- Referral for cerebrovascular assessment should not solely depend on the presence of a carotid bruit.
- All patients with suspected carotid territory ischemia warrant specialist evaluation.
Abstract:
A carotid bruit is often thought of as a reliable sign of extracranial carotid artery disease. In addition finding a bruit may precipitate a referral to hospital. Carotid endarterectomy has now been shown to be beneficial in patients with symptomatic carotid territory ischaemia and 70-99% stenosis of the relevant carotid artery, therefore it is important that such patients are detected and referred. In this study of 331 consecutive patients referred to a specialist cerebrovascular clinic we examined the practical value of a carotid bruit mentioned by the referring practitioner. All patients underwent clinical assessment, evaluation of risk factors and Doppler duplex scanning of the carotid arteries. A bruit was stated in the referral letter of 110 (33%) patients. Moderate (30-69%) or severe (70-99%) stenosis was present in 37% of patients with, and 17% of those without a carotid bruit (P < 0.001). We found a carotid bruit was a poor predictor of such disease (positive predictive value, 37%). The false negative rate for severe disease was 43%. Normal carotid arteries were found in 32% of patients with a bruit. We therefore suggest that all patients with suspected carotid territory ischaemia should be referred for assessment whether there is a bruit present or not.