A clinical vignette: the clinical significance of systolic-diastolic bruits in the carotid arteries1
Most authorities agree that an arterial bruit that extends into diastole usually indicates severe stenosis in the underlying artery. Less well known is that a systolic-diastolic bruit at the carotid artery bifurcation indicates that, not only is the underlying artery severely narrowed, but the contralateral carotid artery is also frequently severely stenosed or occluded. In 1956, Myers described systolic-diastolic bruits in the aortic arch syndrome and suggested the hemodynamic etiology. The severity of the lesions in 40 patients with a systolic-diastolic bruit seen at The Cleveland Clinic Foundation over a one year period was checked by reviewing the corresponding arteriograms. Ipsilateral to the bruit, 88% of the carotid arteries were narrowed by greater than 70%. On the side contralateral to the bruit, 80% of the carotid arteries were narrowed by greater than 70%. These studies confirm that a systolic-diastolic bruit often indicates severe bilateral carotid artery disease.