Symptoms, stenosis, and bruit: interrelationships in carotid artery disease.

The relationship between focal neurologic symptoms, carotid artery stenosis, and cervical bruits was studied in 495 patients. Among the 990 carotid arteries, 562 (57%) were considered to be symptomatic and 505 (51%) were associated with bruit. There was a linear relationship between the degree of stenosis and symptoms. Of the highly stenotic vessels (80% to 99% narrowing), 253 of 350 (72%) were symptomatic; 85 of 104 (82%) occluded vessels were symptomatic. There was a linear relationship between the occurrence of cervical bruit and degree of stenosis, up to but not including total occlusion. The relationship between bruits and focal neurologic symptoms was less direct. Among 562 symptomatic arteries, 297 (53%) had a bruit and 265 (47%) did not. In symptomatic patients, the absence of a cervical bruit should not delay a workup for extracranial vascular disease.