Stenosis of the external or internal carotid artery creates turbulence which is manifested as a bruit during auscultation over the distribution of the involved artery. Since stroke is the third leading cause of death in the United States and is most often due to disease of the carotid artery, all bruits should be evaluated with respect to whether or not they are clinically significant, causing symptoms, and whether or not surgical correction is justified. Bruits may be a manifestation of systemic vascular disease, especially coronary artery disease, and a detailed history with this in mind should be undertaken. Risk factors for vascular disease include diabetes, smoking, hypertension and prior heart disease such as myocardial infarction and angina. Most of the morbidity associated with carotid endarterectomy is due to coronary artery disease, the presence of which should be determined before carotid endarterectomy. A prior history of transient ischemic attacks (TIA) or stroke places the patient in a different category and this is discussed in detail under the algorithm entitled “Extracranial Cerebrovascular Disease.”
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