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Vladimir Hachinski, MD
Arch Neurol. 1985;42(4):385-385. doi:10.1001/archneur.1985.04060040099021
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Noisy arteries get attention, but prospective epidemiologic studies suggest that a stroke occurs as often in the territory of a silent carotid artery as in the territory of the artery with a bruit.1,2 Based on the Evans County, Georgia,1 data and the Framingham study,2 Yatsu and Fields estimate that the incidence of ischemic stroke ipsilateral to the bruit is 0.1% and 0.4% per year, respectively, or about 0.25% per year. Allowing for the observation that only about half of patients with cervical bruits have a hemodynamically significant lesion,3,4 the risk of relevant stroke amounts to about 0.5% per year or one quarter the risk of immediate morbidity or mortality (2%) set as a maximum by Quiñones-Baldrich and Moore. This represents an exceptionally high standard; the mortality from carotid endarterectomy for all indications in the United States in 1982 was 2.8% among 85,000 procedures, and the incidence

REFERENCES

Heyman A, Wilkinson WE, Heyden S, et al:  Risk of stroke in asymptomatic persons with cervical arterial bruits: A population study in Evans County, Georgia . N Engl J Med 1980;; 302:838-841.
Wolf PA, Kannel WB, Sorlie P, et al:  Asymptomatic carotid bruit and risk of stroke: The Framingham study . JAMA 1981;;245:1442-1445.
David TE, Humphries AW, Young JR, et al:  A correlation of neck bruits and atherosclerotic carotid arteries . Arch Surg 1973;;107:729-731.
Moore WS, Bean B, Burton R, et al:  The use of ophthalmosonometry in the diagnosis of carotid artery stenosis . Surgery 1977;;82:107-115.
Dyken ML, Pokras R: The performance of endarterectomy for disease of the extracranial arteries of the head. Stroke, in press.
Hart RG, Easton DJ:  Management of cervical bruits and carotid stenosis in preoperative patients . Stroke 1983;;14:290-297.
Ropper AH, Wechsler LR, Wilson LS:  Carotid bruit and the risk of stroke in elective surgery . N Engl J Med 1982;;307:1388-1390.
Hennerici M, Rautenberg W, Mohr S:  Stroke risk from symptomless extracranial arterial disease . Lancet 1982;;2:1180-1183.

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Heyman A, Wilkinson WE, Heyden S, et al:  Risk of stroke in asymptomatic persons with cervical arterial bruits: A population study in Evans County, Georgia . N Engl J Med 1980;; 302:838-841.
Wolf PA, Kannel WB, Sorlie P, et al:  Asymptomatic carotid bruit and risk of stroke: The Framingham study . JAMA 1981;;245:1442-1445.
David TE, Humphries AW, Young JR, et al:  A correlation of neck bruits and atherosclerotic carotid arteries . Arch Surg 1973;;107:729-731.
Moore WS, Bean B, Burton R, et al:  The use of ophthalmosonometry in the diagnosis of carotid artery stenosis . Surgery 1977;;82:107-115.
Dyken ML, Pokras R: The performance of endarterectomy for disease of the extracranial arteries of the head. Stroke, in press.
Hart RG, Easton DJ:  Management of cervical bruits and carotid stenosis in preoperative patients . Stroke 1983;;14:290-297.
Ropper AH, Wechsler LR, Wilson LS:  Carotid bruit and the risk of stroke in elective surgery . N Engl J Med 1982;;307:1388-1390.
Hennerici M, Rautenberg W, Mohr S:  Stroke risk from symptomless extracranial arterial disease . Lancet 1982;;2:1180-1183.

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