Carotid bruit

Seemant Chaturvedi MD (Dr. Chaturvedi of Wayne State University received grant support from Boehringer Ingelheim and consulting fees from Merck.)
Steven R Levine MD, editor. (Dr. Levine of the SUNY Health Science Center at Brooklyn has received honorariums from Genentech for service on a scientific advisory committee and a research grant from Genentech as a principal investigator.)
Originally released April 24, 1995; last updated September 4, 2015; expires September 4, 2018

This article includes discussion of carotid bruit, cervical murmur, asymptomatic bruits, and symptomatic bruits. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

The author summarizes new information on management of patients with asymptomatic carotid bruits. Information regarding risk stratification for patients with asymptomatic carotid stenosis is presented. The recommendation against screening for asymptomatic carotid stenosis is provided. Comparative data on carotid endarterectomy and stenting are also provided. Finally, clinical trials that have been launched for this patient population are described.

Key points

 

• Asymptomatic carotid stenosis is present in 4% to 6% of subjects age 65 years and older.

 

• Asymptomatic carotid stenosis increases the stroke risk to a slight degree, but the risk is much lower compared to symptomatic patients.

 

• Carotid endarterectomy can be useful for highly select patients if the major complication rate is low (less than 3%) and if the patient has at least a 5-year life expectancy.

 

• Intensive medical therapy is needed for all patients with carotid stenosis.

Historical note and terminology

The earliest report linking carotid artery disease with stroke is credited to Savory, who, in 1856, described a young woman with left monocular symptoms in combination with a right hemiplegia. Postmortem examination revealed an occlusion of the cervical portion of the left internal carotid artery. In 1914, Hunt emphasized the connection between obstructive lesions of the carotid artery and the development of neurologic symptoms. In 1957, Fisher brought attention to the relationship between carotid artery bruit and cerebrovascular disease when he described a 69-year-old woman with carotid artery bruits bilaterally who had sudden onset of weakness in her right leg (Fisher 1957). He also pointed out that lesions could result in either stenosis or total occlusion. In the following decade, these observations were confirmed, and a carotid bruit localized to the carotid bifurcation was considered to be indicative of carotid atherosclerosis.

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