Carotid Bruits and Cerebrovascular Disease Risk

Abstract

Background and Purpose-Current guidelines recommend against routine auscultation of carotid arteries, believing that carotid bruits are poor predictors of either underlying carotid stenosis or stroke risk in asymptomatic patients. We investigated whether the presence of a carotid bruit is associated with increased risk for transient ischemic attack, stroke, or death by stroke (stroke death). Methods-We searched Medline (1966 to December 2009) and EMBASE (1974 to December 2009 with the terms "carotid" and "bruit." Bibliographies of all retrieved articles were also searched. Articles were included if they prospectively reported the incidence of transient ischemic attack, stroke, or stroke death in asymptomatic adults. Two authors independently reviewed and extracted data. Results-We included 28 prospective cohort articles that followed a total of 17 913 patients for 67 708 patient-years.Among studies that directly compared patients with and without bruits, the rate ratio for transient ischemic attack was 4.00 (95% CI, 1.8 to 9.0, PϽ0.0005, nϭ5 studies), stroke was 2.5 (95% CI, 1.8 to 3.5, PϽ0.0005, nϭ6 studies), and stroke death was 2.7 (95% CI, 1.33 to 5.53, Pϭ0.002, nϭ3 studies). Among the larger pool of studies that provided data on rates, transient ischemic attack rates were 2.6 per 100 patient-years (95% CI, 2.0 to 3.2, PϽ0.0005, nϭ24 studies) for those with bruits compared with 0.9 per 100 patient-years (95% CI, 0.2 to 1.6, Pϭ0.02, nϭ5 studies) for those without carotid bruits. Stroke rates were 1.6 per 100 patient-years (95% CI, 1.3 to 1.

Population-Attributable Risks for Ischemic Stroke in a Community in South Brazil: A Case-Control Study

“…Third, the absence of confirmation of carotid stenosis by an image method is a potential limitation of our study, since carotid bruits are poor predictors of either underlying carotid stenosis or stroke risk in asymptomatic patients. On the other side, Pickett et al described in a meta-analysis with 28 cohort studies that patients with a carotid bruit have four times the risk of transient ischemic attack and twice the risk of stroke when compared with controls [25]. If the negative likelihood ratio described by Johansson et al is applied to our high risk sample (cases), where the prevalence of carotid bruit was 24%, the absence of this clinical sign would have a post-test probability of only 5% for severe carotid stenosis [26] Fourth, our patients were recruited from a single center and patients with less than 45 years and with previous neurological disease were not selected.…”

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“…Patients with a carotid bruit have a >4 times higher risk of TIA, twice the risk of stroke, and an increased risk of death from stroke when compared to controls without carotid bruits [39]. …”

The clinical import of a retinal cholesterol embolus: it is a question of symptoms

“…Bruits are the result of turbulent hemodynamic flow through stenotic lesions and can develop once arterial lumen is reduced to less than 50%. 23 Although the presence of a carotid bruit has been associated with an increased risk of cerebrovascular disease, 24 this clinical finding is also coupled with poor predictive value for confirmatory Doppler duplex scanning (43%) and confounded by the finding that one-third of patients with a bruit have normal ultrasounds (false positives, with respect to bruits). 25 Conversely, one-third of patients with high-grade carotid stenosis manifest no bruit (false negatives with respect to bruits).…”