Carotid artery auscultation--anachronism or useful screening procedure?
Carotid bruits are supposed to indicate the presence of high-grade common carotid or extracranial internal carotid artery stenosis in a large proportion of patients. Using a stethoscope, we prospectively auscultated 273 carotid arteries of 145 patients blinded to the results of a complete extracranial and intracranial Doppler investigation including extracranial color-coded duplex ultrasound. Fifty-four arteries showed stenosis of > or = 50%-99%, or occlusion of the extracranial internal or the common carotid artery. In 25 of these arteries, a bruit was present. In 9 out of 16 patients with extracranial stenosis from 70%-99%, a bruit was detected. In one additional patient with a middle-grade external carotid artery stenosis, a bruit was also present. In seven additional patients, a bruit was present in the absence of any carotid artery stenosis, cardiac vitium or goiter. The sensitivity of carotid auscultation for the detection of a 70%-99% stenosis of the common or extracranial internal carotid artery was 56% and specificity was 91%. The positive predictive value of a bruit found during carotid auscultation was 27%, and the negative predictive value of a normal auscultation was 97%. Carotid auscultation is a useful screening procedure in the detection of carotid stenosis or occlusion, but requires confirmation by carotid ultrasound.
Magyar
M Tünde
MT
Department of Neurology, University of Debrecen, Hungary.
Nam
Eun-Mi
EM
Csiba
László
L
Ritter
Martin A
MA
Ringelstein
E Bernd
EB
Droste
Dirk W
DW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001314:Auscultation / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D018616:Ultrasonography, Doppler, Duplex / Q000592:standards / Q000706:statistics & numerical data*