Management of asymptomatic carotid bruit.
One hundred forty-nine consecutive patients who had peripheral arterial disease (PAD) with clinically audible asymptomatic bruits were studied. Sixty-two of these patients were age- and sex-matched with 62 PAD patients in whom no bruits were detected. The PAD was demonstrated by angiography or by the 1-minute exercise test. Clinical assessment was performed every 6 months and oculoplethysmography and carotid phonoangiography (OPG/CPA) were performed every year. Angiography and reconstructive surgery were performed only if symptoms of transient ischemic attack (TIA) or stroke occurred. Life-table analysis revealed that over a 5.5-year follow-up, 32% of 211 PAD patients were expected to die. In the control study 45% of bruit patients and 32% of control patients were expected to die (no significant difference). Myocardial infarction accounted for 59% of deaths in the bruit group compared with 28% in the control group (no significant difference). TIA occurred more commonly in the bruit group (26.5%) than in the controls (6%) (p less than 0.02). However, stroke without warning occurred in 9% of bruit patients compared with 8% of controls (no significant difference). It is concluded that for asymptomatic carotid bruit it is safe to wait for the onset of symptoms before angiography and corrective reconstructive surgery.
D000206:Actuarial Analysis; D000368:Aged; D000369:Aged, 80 and over; D001314:Auscultation / Q000295:instrumentation; D002339:Carotid Arteries; D002340:Carotid Artery Diseases / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D013997:Time Factors