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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-.

StatPearls [Internet].

Show detailsTreasure Island (FL): StatPearls Publishing; 2026 Jan-.Search term Carotid Bruit

Fidel Valero; Ramsis Benjamin; James Espinosa.

Author Information and Affiliations

Authors

Fidel Valero; Ramsis Benjamin1; James Espinosa2.

Affiliations

1 University of Texas Rio Grande Valley (UTRGV)2 Rowan/SOM, Jefferson-Stratford

Last Update: January 31, 2026.

Continuing Education Activity

A carotid bruit is a high-pitched vascular sound caused by turbulent blood flow, most often due to atherosclerotic narrowing, but it may also arise from nonsclerotic, inflammatory, structural, or high-output conditions. Once regarded as a strong predictor of stroke and an indication for surgical intervention, carotid bruits are now understood as one component of a broader vascular risk assessment that includes age, blood pressure, metabolic factors, and smoking history. Modern data demonstrate that many asymptomatic bruits do not progress to stroke, underscoring the need for judicious evaluation and selective imaging. This activity reviews carotid bruits, emphasizing their pathophysiology, historical significance, diagnostic limitations, and contemporary clinical relevance.

This course outlines carotid auscultation techniques, differentiation of bruits from other cervical vascular sounds, and interpretation of findings in the appropriate clinical context. Participants will also gain practical guidance on when further diagnostic testing, referral, or interprofessional collaboration is warranted, as well as current medical and procedural management strategies aligned with evolving evidence. This activity for healthcare professionals is designed to enhance the learner's competence in identifying carotid bruit, performing the recommended evaluation, including indicated vascular risk assessments, and implementing an appropriate interprofessional approach when managing this condition to improve patient outcomes

Objectives:

Identify the acoustic features of carotid bruits that distinguish them from cardiac murmurs.
Differentiate atherosclerotic carotid stenosis from other causes of cervical bruits.
Determine when additional diagnostic imaging is warranted for patients with a carotid bruit based on risk stratification.
Collaborate with interprofessional team strategies to improve care coordination when evaluating a carotid bruit.

Access free multiple choice questions on this topic.

Introduction

A bruit (French pronunciation “brooee”), unlike a murmur arising from coronary valves, represents a higher-pitched swooshing or whooshing sound auscultated over a noncardiac blood vessel, either an artery or a vein. Turbulent blood flow through a narrowed lumen produces this sound, most often when luminal narrowing exceeds 50% of the original cross-sectional diameter, primarily because of atherosclerotic plaque formation. Following the invention of the stethoscope (“chest scope”) by René Laënnec in 1816, who also introduced the terms auscultation, bruit, and rales, and the subsequent development of the binaural stethoscope by Arthur Leared and George Cammann by the mid-1850s, clinicians gained the ability to detect bruits over the anterior triangle of the neck where the carotid arteries course.[1][2] During the mid-20th century, identification of a carotid bruit on auscultation suggested increased stroke risk and stimulated interest in carotid bypass surgery for asymptomatic patients; however, contemporary evidence has challenged these perceived benefits. Large studies, including those involving older adult populations, demonstrate that many asymptomatic bruits fail to progress to stroke, and some resolve over time.[3]

In current practice, a carotid bruit functions as one component of a comprehensive clinical diagnostic index that also includes age, blood pressure, cholesterol levels, diabetes status, and smoking history. Among patients classified as high risk, additional evaluation with carotid duplex ultrasonography may remain appropriate, regardless of the presence or absence of a bruit on auscultation.[4]

Etiology

Atherosclerotic plaques commonly form within arteries arising from the aortic arch. Approximately 80% of these lesions localize at the bifurcation of the common carotid arteries.[5] During the physical examination, clinicians perform carotid artery auscultation to evaluate whether carotid stenosis may predispose a patient to stroke. Among patients with a 2 mm reduction in carotid artery luminal diameter, a carotid bruit appears in 70% to 89% of cases.[6]

Luminal narrowing, however, does not represent the sole cause of a carotid bruit. Cardiac valvular murmurs that radiate into the neck, cervical venous hums, and intracranial arteriovenous malformations may generate vascular sounds that resemble a carotid bruit.[5] Arterial tortuosity, kinking, and high-output physiologic states also can produce bruits in normal or minimally stenotic arteries. In thyrotoxicosis, a 5- to 10-fold increase in blood flow to an enlarged thyroid gland may lead to a systolic bruit heard directly over the glandular isthmus.[5] Rarely, a bovine-type aortic arch combined with compression of kissing carotid arteries by a retrosternal goiter may serve as the source of a carotid bruit.[7][8]

Extrinsic vascular compression causing occlusion, including carotid body tumors and carotid paragangliomas, has also been reported to generate carotid bruits.[5][9][10] Structural disruption of the arterial wall occurs in conditions, eg, carotid artery dissection and aneurysm, both of which have been associated with bruit formation.[11][12]

Inflammatory involvement of the carotid vessels, as seen in disorders, eg, Takayasu arteritis, may also produce a carotid bruit.[13] Arterial bruit now serves as a component of the updated classification criteria for Takayasu arteritis.[14] Nonsclerotic and noninflammatory disorders, including fibromuscular dysplasia, frequently involve the internal carotid arteries and may result in an incidental carotid bruit during examination. Cervical fibromuscular dysplasia typically follows an asymptomatic course.[15][16]

Epidemiology

A carotid bruit represents a nonspecific clinical finding with wide sensitivity ranging from 24% to 84%.[17] Approximately 5% of individuals aged 45 to 80 years without clinically significant internal carotid artery disease demonstrate a carotid bruit on examination.[18] Among patients with an audible carotid bruit, one-third have hemodynamically significant stenosis defined as 70% to 90% luminal narrowing. Conversely, among patients with high-grade carotid artery stenosis, only about half exhibit a bruit during carotid auscultation.[19][20]

A soft, early systolic sound emerges when the arterial lumen narrows by approximately 50%. As stenosis progresses toward 60%, the bruit increases in intensity and pitch and extends throughout systole. With further reduction of luminal diameter to 70% to 80%, the bruit may persist into early diastole. Progressive occlusion eventually reduces turbulent flow to a degree that fails to generate arterial wall vibrations, leading to attenuation or disappearance of the bruit.[5]

Carotid bruits also appear in approximately 20% of healthy children younger than 15 years. Nearly 22% of patients diagnosed with cervical fibromuscular dysplasia demonstrate carotid bruits, although most affected individuals remain asymptomatic.[21]

Pathophysiology

The bruit typically implies stenosis at or proximal to the area of auscultation. The auscultated sound is usually the result of turbulent, nonlaminar blood flow through a stenotic area. The turbulent flow creates vibrations in the arterial wall that transmit to the body surface, where auscultation is possible. Critical stenosis, however, occurs only when the cross-sectional area decreases to 70%, corresponding to a reduction in luminal diameter by half. The auscultatory quality and timing of the bruit change with the degree of stenosis and pressure gradients. (Please refer to the Epidemiology section for more information.)

History and Physical

Assessment of cerebrovascular risk begins with a thorough medical history followed by a focused physical examination. Patients undergoing evaluation for carotid bruits should assume a supine or seated position. During seated examinations, carotid palpation and auscultation achieve optimal accuracy when the clinician approaches from behind. With the patient’s chin directed straight forward, placement of either the stethoscope bell or diaphragm over each carotid artery should create a complete seal with the overlying skin.

The diaphragm facilitates detection of high-frequency sounds, including respiratory noises, and requires firm pressure against the skin, whereas the bell enhances perception of low-frequency sounds such as selected cardiac murmurs and vascular bruits when applied with light pressure. Clinicians then instruct the patient to hold a deep breath without performing a Valsalva maneuver for 10 to 20 seconds. Breath-holding minimizes extraneous sounds and enhances the audibility of a carotid bruit.[5]

Auscultation yields the most clinically relevant information when performed at the following 3 key locations:

The proximal carotid artery, where the murmurs from the heart valves and great vessels radiate upward
The common carotid artery bifurcation at the angle of the mandible (the usual site of plaque buildup)
Over the orbit where carotid-cavernous fistulas occur [22]

Nonobstructive lesions typically generate a brief, low-pitched, rumbling bruit, whereas high-grade obstructive lesions more often produce a high-pitched, prolonged bruit that may extend into diastole.[23][24] Lesions associated with severe stenosis exceeding 90% commonly produce faint sounds or no audible bruit at all.[23]

Evaluation

Detection of a carotid bruit may prompt clinical suspicion for carotid artery disease, yet auscultation alone lacks sufficient sensitivity and specificity to establish a definitive diagnosis.[25] An electronic stethoscope with spectral analysis shows promise for identifying severe carotid stenosis, although limited sensitivity restricts reliable detection of atherosclerotic plaque.[26] Following recognition of a carotid bruit, clinicians must determine the need for additional diagnostic testing or specialty referral by integrating vascular risk factors with associated signs and symptoms suggestive of neurologic or vascular disease.

Diagnostic imaging modalities, including carotid duplex ultrasonography, computed tomography angiography, and magnetic resonance angiography of the head and neck, support confirmation of disease and delineation of vascular anatomy when surgical or endovascular intervention becomes a consideration.[27] Interprofessional collaboration with neurology and cardiology specialists is frequently employed to help guide comprehensive evaluation and management decisions.

Treatment / Management

Upon confirmation of carotid artery disease as the source of the carotid bruit, a management approach comprising medical and surgical treatment should be initiated based on the severity of stenosis, the presence or absence of neurological symptoms, and the patient's comorbidities. Surgical options include conventional endarterectomy or the minimally invasive TCAR (TransCarotid Artery Revascularization) procedure via open cut-down access to the proximal common carotid artery for sheath insertion, creating an arteriovenous shunt for flow reversal, and endovascular stent insertion.[28]

Although the common practice has been to provide longitudinal monitoring and aggressive medical management in asymptomatic carotid stenosis of 90% or less, in the well-anticipated multicenter CREST2 trial, carotid-artery stenting plus intensive medical management demonstrated a lower risk of a composite of perioperative stroke or death or ipsilateral stroke within 4 years than intensive medical management alone.[29] Furthermore, carotid endarterectomy did not produce any significant benefit in the CREST2 study, reaffirming the long-held belief.

Differential Diagnosis

Differential diagnosis for carotid bruit includes:

Cardiac valvular murmurs
Carotid artery vasculitis (Takayasu arteritis)
Carotid body tumor (paraganglioma)
Carotid dissection and aneurysm
Goiter and thyrotoxicosis
Carotid-venous fistula
Cervical fibromuscular dysplasia
Subclavian venous hum

Prognosis

While carotid bruits have been regarded as markers of generalized atherosclerosis, the data have failed to show them as strong predictors of cerebrovascular events. However, carotid bruit auscultation is a rapid, noninvasive assessment that may help identify patients who might benefit most from aggressive cardiovascular risk stratification and therapeutic interventions.[30]

Complications

The annual incidence of cerebrovascular accidents in people with asymptomatic bruits is about 1% to 3%.[19] Carotid artery disease contributes to 15% to 20% of all ischemic strokes.[31]

Consultations

Consultations typically requested for people with carotid bruit include neurology, vascular surgery, and cardiology.

Deterrence and Patient Education

Deterrence of adverse cerebrovascular outcomes in patients with a carotid bruit centers on risk modification rather than reliance on the auscultatory finding alone. Patient education should clarify that a carotid bruit does not reliably predict stroke or the severity of carotid artery disease, yet the finding often reflects underlying vascular risk that warrants attention. Clinicians play a key role in explaining the multifactorial nature of cerebrovascular risk, including the contributions of hypertension, hyperlipidemia, diabetes, smoking, and age, and in reinforcing that the absence or presence of a bruit does not equate to safety or danger in isolation. Clear communication reduces anxiety, discourages unnecessary expectations for invasive procedures, and promotes informed participation in care decisions.

Patient education should also emphasize the importance of aggressive lifestyle modification and adherence to evidence-based medical therapy when vascular risk factors exist. Counseling should address smoking cessation, dietary changes, physical activity, and adherence to antihypertensive, lipid-lowering, and antiplatelet therapies when indicated. Clinicians should individualize recommendations based on comorbidities and overall risk profile while stressing the long-term benefits of compliance. Ongoing follow-up and coordination with primary care, cardiology, and neurology support sustained risk reduction and reinforce preventive strategies aimed at lowering the likelihood of future cerebrovascular events.

Pearls and Other Issues

Asymptomatic carotid bruits are not infrequent, and their prevalence increases with age. The physical finding of carotid bruit on examination has low accuracy, and a bruit alone does not indicate carotid artery disease. However, if sensibly incorporated into the patient's clinical assessment and risk stratification, it remains a viable tool in identifying patients at risk for a neurovascular event.

Enhancing Healthcare Team Outcomes

Carotid bruits represent auscultatory sounds generated by turbulent blood flow within cervical vessels, most commonly associated with atherosclerotic narrowing of the carotid arteries but also arising from nonsclerotic, inflammatory, structural, or high-output states. Historically viewed as a strong marker of stroke risk, carotid bruits now function as a nonspecific clinical sign with limited sensitivity and specificity. Contemporary evidence supports interpretation of a bruit within a broader vascular risk assessment that includes age, blood pressure, lipid status, diabetes, and smoking. Proper auscultation technique and recognition of alternative causes remain essential, while confirmatory imaging and selective referral guide further evaluation and management.

Optimal care requires coordinated skills and strategies across the interprofessional team. Physicians, general practitioners, and advanced practitioners integrate history, physical examination, and risk stratification to determine the need for imaging or specialty referral. Nurses reinforce education, perform focused assessments, and monitor adherence to preventive strategies. Pharmacists optimize medical therapy and counsel on medication safety and compliance. Effective communication among cardiology, neurology, vascular specialists, and primary care ensures timely diagnosis, minimizes unnecessary interventions, and supports individualized risk reduction, enhancing patient safety, outcomes, and overall team performance.

Review Questions

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Comment on this article.

Figure

Bruit Assessment Sites. The 3 most frequent sites to assess for a bruit: (1) proximal to the upstroke of cardiac murmurs; (2) at the angle of the mandible and the carotid bifurcation; and (3) over the orbit to assess for carotid-cavernous fistula. Contributed (more...)

References

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Butterworths; Boston: 1990. [PubMed: 21250132]6.Aronson L, Landefeld CS. Examining older people for carotid bruits: listen to your patient, not her neck. J Gen Intern Med. 1998 Feb;13(2):140-1. [PMC free article: PMC1496909] [PubMed: 9502377]7.Aykan AÇ, Karadeniz A, Çavuşoğlu İG. Case Image: Bovine-type aortic arch and compression of the kissing carotid arteries by a retrosternal goiter: An uncommon cause of carotid bruit. Turk Kardiyol Dern Ars. 2018 Mar;46(2):165. [PubMed: 29512622]8.Yagi T, Kawasaki T. Goiter, Bounding Pulses, and Thyroid Bruit in Thyroid Storm. N Engl J Med. 2025 Nov 06;393(18):e31. [PubMed: 41181906]9.Anand J, Singh JP. Bilateral sporadic carotid body tumors-A rare case report. Radiol Case Rep. 2018 Oct;13(5):988-992. [PMC free article: PMC6091435] [PubMed: 30116460]10.Peric B, Marinsek ZP, Skrbinc B, Music M, Zagar I, Hocevar M. A patient with a painless neck tumour revealed as a carotid paraganglioma: a case report. World J Surg Oncol. 2014 Aug 20;12:267. [PMC free article: PMC4153909] [PubMed: 25141773]11.Demiryoguran NS, Karcioglu O, Topacoglu H, Aksakalli S. Painless aortic dissection with bilateral carotid involvement presenting with vertigo as the chief complaint. Emerg Med J. 2006 Feb;23(2):e15. [PMC free article: PMC2564071] [PubMed: 16439729]12.Jaha L, Ademi B, Rudari H, Vokrri L, Gjikolli B, Koshi A, Kuçi A, Jaha A. Surgical management of extracranial internal carotid artery aneurysm-Case report and literature review. Clin Case Rep. 2023 Oct;11(10):e8015. [PMC free article: PMC10547859] [PubMed: 37799567]13.Silver M. Takayasu's Arteritis - An Unusual Cause of Stroke in a Young Patient. West J Emerg Med. 2012 Dec;13(6):484-7. [PMC free article: PMC3555585] [PubMed: 23359834]14.Grayson PC, Ponte C, Suppiah R, Robson JC, Gribbons KB, Judge A, Craven A, Khalid S, Hutchings A, Danda D, Luqmani RA, Watts RA, Merkel PA., DCVAS Study Group. 2022 American College of Rheumatology/EULAR classification criteria for Takayasu arteritis. Ann Rheum Dis. 2022 Dec;81(12):1654-1660. [PubMed: 36351705]15.Plouin PF, Perdu J, La Batide-Alanore A, Boutouyrie P, Gimenez-Roqueplo AP, Jeunemaitre X. Fibromuscular dysplasia. Orphanet J Rare Dis. 2007 Jun 07;2:28. [PMC free article: PMC1899482] [PubMed: 17555581]16.Dicks AB, Gornik HL, Gu X, Bacharach JM, Fendrikova Mahlay N, Froehlich JB, Gupta K, Gray BH, Kim ESH, Mahmood R, Sharma AM, Wells BJ, Olin JW, Weinberg I. Association of Fibromuscular Dysplasia and Pulsatile Tinnitus: A Report of the US Registry for Fibromuscular Dysplasia. J Am Heart Assoc. 2021 Sep 07;10(17):e021962. [PMC free article: PMC8649251] [PubMed: 34459232]17.McColgan P, Bentley P, McCarron M, Sharma P. Evaluation of the clinical utility of a carotid bruit. QJM. 2012 Dec;105(12):1171-7. [PubMed: 22886230]18.Grotta JC. Carotid stenosis. N Engl J Med. 2013 Dec 12;369(24):2360-1. [PubMed: 24328480]19.Louridas G, Junaid A. Management of carotid artery stenosis. Update for family physicians. Can Fam Physician. 2005 Jul;51(7):984-9. [PMC free article: PMC1479527] [PubMed: 16060177]20.Sauvé JS, Thorpe KE, Sackett DL, Taylor W, Barnett HJ, Haynes RB, Fox AJ. Can bruits distinguish high-grade from moderate symptomatic carotid stenosis? The North American Symptomatic Carotid Endarterectomy Trial. Ann Intern Med. 1994 Apr 15;120(8):633-7. [PubMed: 8135446]21.Olin JW, Froehlich J, Gu X, Bacharach JM, Eagle K, Gray BH, Jaff MR, Kim ES, Mace P, Matsumoto AH, McBane RD, Kline-Rogers E, White CJ, Gornik HL. The United States Registry for Fibromuscular Dysplasia: results in the first 447 patients. Circulation. 2012 Jun 26;125(25):3182-90. [PubMed: 22615343]22.Ekvtimishvil E, Meher A, Johnson J. Echoes of Trauma: DSA-Guided Coil Embolization for Carotid Cavernous Fistula Presenting with Ocular Bruit and Pulsatile Exophthalmos. Discoveries (Craiova). 2025 Jan-Mar;13(1):e203. [PMC free article: PMC12062737] [PubMed: 40351506]23.Machleder HI. Strokes, transient ischemic attacks and asymptomatic bruits. West J Med. 1979 Mar;130(3):205-17. [PMC free article: PMC1238572] [PubMed: 371149]24.Ochsner JL. Carotid bruit. The physician's dilemma. Postgrad Med. 1981 Oct;70(4):57-9, 62-6. [PubMed: 7291094]25.van der Worp HB, van Gijn J. Clinical practice. Acute ischemic stroke. N Engl J Med. 2007 Aug 09;357(6):572-9. [PubMed: 17687132]26.Malik AEF, Giudici A, Lubrecht JM, Prinzen FW, Delhaas T, Mess WH, Reesink KD. Spectral analysis of bruits with an electronic stethoscope enhances screening of carotid stenosis and plaques beyond conventional auscultation. Ann Transl Med. 2025 Oct 31;13(5):55. [PMC free article: PMC12592010] [PubMed: 41211110]27.Qaja E, Tadi P, Theetha Kariyanna P. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Feb 12, 2024. Symptomatic Carotid Artery Stenosis. [PubMed: 28723054]28.Jim J, Dermody M, Peterson B, Berman SS, Mouawad NJ, Ricotta J, Saqib N, Faries P, Martin A, Adams JD, Tripathy U, Calderon D, O'Connor D, Shah R, Macdonald S, Schermerhorn ML. Prospective, Multicenter Evaluation of Transcarotid Artery Revascularization in Standard-Risk Patients: 30-Day Outcomes of the ROADSTER 3 Study. Ann Neurol. 2026 Mar;99(3):705-712. [PMC free article: PMC12954140] [PubMed: 41277872]29.Brott TG, Howard G, Lal BK, Voeks JH, Turan TN, Roubin GS, Lazar RM, Brown RD, Huston J, Edwards LJ, Jones M, Clark WM, Chamorro Á, Llull L, Mena-Hurtado C, Heck D, Marshall RS, Howard VJ, Moore WS, Barrett KM, Demaerschalk BM, Sangha N, Aronow H, Foster M, Sternbergh WC, Shawl F, Lanzino G, Rapp J, Tran HS, Ecker R, Mackey A, Ali V, Given C, Teal P, Kashyap VS, Mukherjee D, Harrigan M, Silverman S, Koopmann M, Wadley VG, Zhang Y, Rhodes JD, Chaturvedi S, Meschia JF., CREST-2 Investigators. Medical Management and Revascularization for Asymptomatic Carotid Stenosis. N Engl J Med. 2026 Jan 15;394(3):219-231. [PubMed: 41269206]30.Pickett CA, Jackson JL, Hemann BA, Atwood JE. Carotid bruits as a prognostic indicator of cardiovascular death and myocardial infarction: a meta-analysis. Lancet. 2008 May 10;371(9624):1587-94. [PubMed: 18468542]31.Mughal MM, Khan MK, DeMarco JK, Majid A, Shamoun F, Abela GS. Symptomatic and asymptomatic carotid artery plaque. Expert Rev Cardiovasc Ther. 2011 Oct;9(10):1315-30. [PMC free article: PMC3243497] [PubMed: 21985544]

Disclosure: Fidel Valero declares no relevant financial relationships with ineligible companies.

Disclosure: Ramsis Benjamin declares no relevant financial relationships with ineligible companies.

Disclosure: James Espinosa declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

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Cite this PageValero F, Benjamin R, Espinosa J. Carotid Bruit. [Updated 2026 Jan 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-.

In this Page

Continuing Education Activity
Introduction
Etiology
Epidemiology
Pathophysiology
History and Physical
Evaluation
Treatment / Management
Differential Diagnosis
Prognosis
Complications
Consultations
Deterrence and Patient Education
Pearls and Other Issues
Enhancing Healthcare Team Outcomes
Review Questions
References

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