Always be sure to examine a patient's carotid arteries for bruits when concerned about stroke and/or TIA. Bruits suggest the presence of stenosis.
Dijk and colleagues found that patients with > 50% carotid artery stenosis are at high rsk for stroke and TIA.
Bruits are best ascultated by using the bell of the stethoscope and asking the patient to briefly hold their breath while trying to hear the abnormality.
The American Heart Association recommends that symptomatic stenosis of > 50% undergo carotid endarectomy (CEA) within 2 weeks. If CEA is contraindicated, stenting should be pursued. CEA for stenosis of 70% to 99% is typically recommended regardless of symptomatology.
References
Dijk et al. "Carotid Stiffness indicates risk of ischemic stroke and TIA in patients with internal carotid artery stenosis." Stroke. 2004; 35: 2258-2262.
