Rational management of the asymptomatic carotid bruit.

A noninvasive cerebrovascular evaluation has been devised that combines three separate but complimentary procedures: ocular pneumoplethysmography (OPPG), carotid audiofrequency analysis (CAA), and cerebral Doppler analysis. This evaluation has proven particularly useful in examination of the asymptomatic carotid bruit, and the management of such patients is aided by noninvasive testing. Patients with a poorly compensated stenosis (reduced OPPG) are all considered candidates for angiography and surgery. For patients with a well-compensated (normal OPPG) but surgically important stenosis (abnormal CAA or Doppler), angiography and surgery are recommended in selected patients. Angiography and/or surgery are believed safely withheld in all remaining patients. The reliability and effectiveness of this approach is evaluated in a series of 100 consecutive patients with an asymptomatic carotid bruit. There were no false-positive results and only known false-negative interpretation.