Clinical significance of carotid bruits: an innocent finding or a useful warning sign?

OBJECTIVE

To elucidate the clinical relevance of carotid bruits.

METHODS

A search using PubMed was performed using the terms: 'carotid bruit', 'stroke', 'cerebrovascular symptoms', 'carotid artery stenosis' and 'carotid artery disease' in various combinations. The reference lists of the gathered reports were also considered.

RESULTS

Current evidence shows that a carotid bruit is a useful clinical sign with a high specificity (> 90%) for the detection of carotid artery stenosis. The negative predictive value (> 90%), as well as the accuracy (> 90%), of this inexpensive method, are additional advantages. The low sensitivity (< 30%) and low positive predictive values (< 30%) of carotid auscultation are its main disadvantages. A carotid bruit is also a useful indicator of systemic atherosclerosis. Carotid bruits are also associated with a higher prevalence of vascular risk factors.

DISCUSSION

Carotid auscultation is a useful and inexpensive diagnostic tool that should be included as part of a general physical examination. Its clinical relevance in terms of carotid disease, however, needs to be verified by further investigation (e.g. ultrasonography). Since carotid bruits are predictors of systemic atherosclerosis, their detection provides an opportunity to initiate further investigations and preventive measures.