The carotid bruit has long been recognized as an indicator of possible atherosclerotic disease at the carotid bifurcation and possible stroke. While there is no disagreement that patients with cerebrovascular symptoms need prompt examination and treatment, the clinical implication of an asymptomatic carotid bruit is unclear. Does the bruit indicate a significant carotid artery stenosis? Are such patients at increased risk for stroke? More precisely, what is the risk of stroke or death without antecedent transient neurological symptoms that might prompt diagnosis and treatment?
Reports in the literature dealing with the clinical course of patients with asymptomatic carotid disease have provided conflicting information. The risk of stroke has been reported to be as high as 19% in patients with asymptomatic carotid bruits1 and as low as 2% in patients with angiographically proved stenosis followed up to 12 years.2 The debate continues in the articles by Busuttil et al (p