• 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.