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  • Updated 02.10.2020
  • Released 04.24.1995
  • Expires For CME 02.10.2023

Carotid bruit

Introduction

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 are in progress for asymptomatic carotid stenosis 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.

• The utility of carotid endarterectomy or carotid stenting versus intensive medical therapy is the subject of ongoing trials.

• 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 (14). 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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