J. Stephane Sauve, MD; Kevin E. Thorpe, MMath; David L. Sackett, MD; Wayne Taylor, MA; Henry J. M. Barnett, MD; R. Brian Haynes, MD, PhD; Allan J. Fox, MD
To determine whether cervical bruits, alone or combined with other clinical characteristics, can distinguish high-grade (70% to 99%) carotid artery stenoses from less severe stenoses in patients with symptoms of cerebrovascular disease.
Cross-sectional comparison of clinical observations with contemporaneous angiography.
The North American Symptomatic Carotid Endarterectomy Trial (NASCET), a multicenter randomized, controlled trial of carotid endarterectomy.
All patients enrolled in the NASCET from its inception in 1988 to November 1991.
A focal ipsilateral carotid bruit had a sensitivity of 63% and a specificity of 61% for high-grade stenosis and, when absent, only lowered the probability for high-grade stenosis from a pretest value of 52% to a post-test probability of 40%. When combined with four other clinical characteristics (an infarction on computed tomography of the head, a carotid ultrasound scan suggesting more than 90% stenosis, a transient ischemic attack rather than a minor stroke as a qualifying event, and a retinal rather than a hemispheric qualifying event), the predicted probabilities of high-grade stenosis ranged from a low of 18% (when none of the features was present) to a high of 94% (when all the features were present).
Cervical bruits alone were not sufficiently predictive of high-grade symptomatic carotid stenosis to be useful in selecting patients for angiography; they were absent in over one third of patients with high-grade stenosis. When combined with other clinical variables, patients with high or low probabilities of 70% to 99% stenoses could be identified, but this prediction model still missed many individuals with high-grade stenosis, even in this training set of selected patients.
Sauve JS, Thorpe KE, Sackett DL, Taylor W, Barnett HJM, Haynes RB, et al. Can Bruits Distinguish High-Grade from Moderate Symptomatic Carotid Stenosis?. Ann Intern Med. ;120:633–637. doi: 10.7326/0003-4819-120-8-199404150-00002
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Published: Ann Intern Med. 1994;120(8):633-637.
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