Prospective clinicopathophysiologic follow-up study of asymptomatic neck bruit.

Three hundred asymptomatic carotid bruits (ACB) were followed prospectively, clinically, and by duplex ultrasound with Gee/ocular plethysmography (OPG) for a period ranging from one to 72 months (mean, 32 months). All patients underwent baseline duplex/OPG, which was repeated every six months until the endpoint, transient ischemic attack (TIA) or cerebrovascular accident (CVA). One hundred seven had arteriograms. Five classes were identified: class I (normal): 96/300 (32%), 79 of these were followed and one had TIA (1/79, 1.3%); class II (less than 50% stenosis): 118/300 (39%), 105 of these were followed, three had TIA, and one had CVA (4/105, 3.8%); class III (50-60% stenosis): 25/300 (8%), 21 were followed, one had TIA (1/21, 4.7%); class IV (more than 60% stenosis with negative OPG): 39/300 (13%), 34 were followed, three had TIA, and one had CVA (4/34, 11.7%); and class V (more than 60% stenosis with positive OPG): 22/300 (7%), 18 were followed, three had TIA, and one had CVA (4/18, 22.2%). Data was analyzed using chi-square with Yates correction. In conclusion, in ACB 32 per cent had no carotid stenosis and 39 per cent had minimal disease with minimal risk of TIA or stroke. Patients with the most severe stenoses (classes IV and V) had a statistically significantly higher likelihood of TIA or CVA occurring during the follow-up period. This last group (class V) would be ideal for prophylactic carotid endarterectomy.