Asymptomatic carotid bruit and risk of stroke. The Framingham study

P. A. Wolf, W. B. Kannel, P. Sorlie and P. McNamara

Carotid bruit was routinely sought in the Framingham cohort and during eight years appeared in 66 men and 105 women, all of whom were asymptomatic. The incidence increased with age equally in the two sexes from 3.5% at 44 to 54 years, to 7.0% at 65 to 79 years. The eight-year incidence was greater in diabetes and hypertensive subjects. Transient ischemic attacks appeared in eight (two alone) and stroke in 21 of the 171, a stroke rate more than twice expected for age and sex. More often than not, cerebral infarction occurred in a vascular territory different from that of the carotid bruit, often in the posterior circulation, and ruptured aneurysm, embolism from the heart, and lacunar infarction was the mechanism of stroke in nearly half the cases. Incidence of myocardial infarction was also increased twofold in those with asymptomatic carotid bruit. General mortality were also increased; 1.7-fold with men, and 1.9-fold in women, with 79% of the deaths owing to cardiovascular disease, including stroke. Carotid bruit is clearly an indicator of increased stroke risk but chiefly as a general and nonfocal sign of advanced atherosclerotic disease and not necessarily as an indicator of local arterial stenosis preceding cerebral infarction.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Blood Pressure Management in Patients With Acute Ischemic Stroke
Goldstein
Hypertension 2004;43:137-141.
FULL TEXT  

Coronary Risk Evaluation in Patients With Transient Ischemic Attack and Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the Stroke Council and the Council on Clinical Cardiology of the American Heart Association/American Stroke Association
Adams et al.
Circulation 2003;108:1278-1290.
FULL TEXT  

Coronary Risk Evaluation in Patients With Transient Ischemic Attack and Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the Stroke Council and the Council on Clinical Cardiology of the American Heart Association/American Stroke Association
Adams et al.
Stroke 2003;34:2310-2322.
FULL TEXT  

Prospective Evaluation of Carotid Bruit as a Predictor of First Stroke in Type 2 Diabetes: The Fremantle Diabetes Study
Gillett et al.
Stroke 2003;34:2145-2151.
ABSTRACT | FULL TEXT  

Prediction of Mortality by Ultrasound Screening of a General Population for Carotid Stenosis : The Tromso Study
Joakimsen et al.
Stroke 2000;31:1871-1876.
ABSTRACT | FULL TEXT  

Carotid Disease in Patients Scheduled for Coronary Artery Bypass: Analysis of 678 Patients
Birincioglu et al.
ANGIOLOGY 1999;50:9-19.
ABSTRACT  

Risk Factors
Sacco et al.
Stroke 1997;28:1507-1517.
FULL TEXT  

Coronary Heart Disease Risk Factors in Men and Women Aged 60 Years and Older : Findings From the Systolic Hypertension in the Elderly Program
Frost et al.
Circulation 1996;94:26-34.
ABSTRACT | FULL TEXT  

Guidelines for Carotid Endarterectomy : A Multidisciplinary Consensus Statement From the Ad Hoc Committee, American Heart Association
Moore et al.
Circulation 1995;91:566-579.
ABSTRACT | FULL TEXT  

Guidelines for Carotid Endarterectomy : A Multidisciplinary Consensus Statement From the Ad Hoc Committee, American Heart Association
Moore et al.
Stroke 1995;26:188-201.
ABSTRACT | FULL TEXT  

Risk-Benefit Aspects of Surgery for Asymptomatic Carotid Artery Stenosis
Colburn and Moore
PERSPECT VASC SURG ENDOVASC THER 1994;7:6-30.
 

Carotid artery disease and myocardial revascularization
Hornick
Perfusion 1994;9:309-317.
 

Carotid Endarterectomy for Asymptomatic Carotid Stenosis
Haines
NEJM 1993;328:276-279.
FULL TEXT  

Indications for Carotid Endarterectomy: Surgeons vs Neurologists
Zelkovic et al.
VASC ENDOVASCULAR SURG 1992;26:642-648.
ABSTRACT  

A Four Year Clinical and Echographic Follow-up of Asymptomatic Carotid Plaque
Fabris et al.
ANGIOLOGY 1992;43:590-598.
ABSTRACT  

Cervical Bruits: Clinical Correlates of Stenosis
Goldman et al.
ANGIOLOGY 1991;42:491-497.
ABSTRACT  

Asymptomatic Carotid Stenosis: Current Diagnosis and Management
Hobson
PERSPECT VASC SURG ENDOVASC THER 1988;1:141-154.
 

Symptoms and Signs of Carotid Territory Transient Cerebral Ischaemia
Murie et al.
VASC ENDOVASCULAR SURG 1986;20:20-26.
ABSTRACT  

Prevalence of Atherosclerotic Lesions at the Carotid Bifurcation in Patients with Asymptomatic Bruits: An Echo-Doppler (Duplex) Study
Lusiani et al.
ANGIOLOGY 1985;36:235-239.
ABSTRACT  

Enlargement of the Superior Thyroid Artery: an Unusual Cause for a Cervical Bruit
Healy and Brault
ANGIOLOGY 1984;35:579-580.
ABSTRACT