Carotid Bruit

What is a carotid bruit?

A carotid bruit (pronounced “broo-ee”) is the sound of turbulent blood flow in one or more of your carotid arteries. Turbulent flow means your blood isn’t flowing smoothly through your artery. Instead, blood flow is disorganized and choppy. Your carotid arteries are blood vessels in your neck that supply blood to your brain.

A carotid bruit is a clinical sign that your healthcare provider may notice during a routine physical exam. The sound of a carotid bruit may indicate that your carotid artery is narrowed due to plaque buildup. Sometimes, though, a carotid bruit occurs in people with healthy carotid arteries. Plus, some people with severe carotid artery narrowing don’t have a bruit. So, healthcare providers use this sign as just one piece of a much larger puzzle when deciding if you need further testing or treatment.

What do carotid bruits sound like?

A carotid bruit is a whooshing sound that’s similar to water rushing in a fast-moving river. You can’t hear a carotid bruit on your own. Instead, it’s something that your healthcare provider can hear through a stethoscope.

To check for a carotid bruit, your provider gently presses the end of a stethoscope against several different areas in your neck. You may need to inhale and then hold your breath for a few seconds as your provider listens to your blood flow through the stethoscope.

If your provider hears a carotid bruit, they’ll talk with you about what it might mean and whether you need follow-up testing.

What causes a bruit in the carotid artery?

Atherosclerosis is the most common cause of a carotid bruit. Atherosclerosis is a medical term that refers to the buildup of plaque (a fatty substance) in arteries throughout your body. This plaque narrows the lumen (opening) of your arteries, limiting blood flow. Plaque buildup can also lead to the formation of blood clots. A blood clot may block blood flow in the area where it forms. Or, it may travel through your bloodstream to another artery and block blood flow there.

A carotid bruit may indicate you have plaque buildup in your carotid artery. Plaque buildup in your carotid arteries can lead to carotid artery stenosis. This is a narrowing of your carotid artery.

Your carotid arteries play a major role in supplying oxygen-rich blood to your brain. So, if they fill up with plaque, you face a higher risk of a transient ischemic attack (TIA) or an ischemic stroke. In these conditions, blood flow to your brain is interrupted or blocked.

This is why it’s important to learn if you have carotid artery stenosis, and if so, how severe it is. A carotid bruit can be a warning sign that you have plaque buildup. But it doesn’t show how much plaque is present. So, a carotid bruit alone isn’t enough to diagnose you with carotid artery stenosis. Instead, it’s the first step your provider will use to investigate further.

Although plaque buildup is the most common cause of a carotid bruit, changes in blood vessel anatomy can also cause this vascular sound. For example, people who have fibromuscular dysplasia (FMD) may have a carotid bruit. Your healthcare provider will look at your medical history to help determine the cause of your carotid bruit.

How serious is a carotid bruit?

A carotid bruit may be a sign of a serious problem, but that’s not always the case. It’s sometimes a red flag showing you may have carotid artery stenosis. If your stenosis is severe, you’ll likely need treatment to lower your risk of a TIA or stroke. Your provider will tell you if your condition is serious and if you need treatment.

Can a carotid bruit be normal?

A carotid bruit doesn’t always indicate you have carotid artery stenosis. Some people with a carotid bruit don’t have significant plaque buildup and are otherwise healthy. Some people may have changes in their blood vessel anatomy, which can be normal or due to conditions like FMD. That’s why a carotid bruit is only the first step in diagnosing and treating carotid artery disease.

What happens next if I have a carotid bruit?

The presence of a carotid bruit will alert your provider that something may be wrong. Your provider may order further testing to evaluate the health of your carotid arteries. Such testing usually involves a carotid duplex ultrasound. This is a painless, noninvasive test that checks blood flow in your carotid arteries. It can show if your arteries are narrowed, and if so, how much.

Your provider will likely order such testing if you have a carotid bruit along with one or more risk factors for carotid artery stenosis. These include:

• Coronary artery disease.
• Diabetes mellitus (type 1 or type 2).
• Family history of a stroke.
• High blood pressure.
• High cholesterol.
• Older age (over 65, or over 55 if you have other risk factors).
• Peripheral artery disease.
• Tobacco use.

The more risk factors you have, the higher your risk of carotid artery stenosis.

If you need coronary artery bypass grafting (CABG), your provider may first order testing to check your carotid arteries. This is because carotid artery stenosis raises your risk of a stroke during or after some heart surgeries. You may need treatment before your surgery to lower your risk.

What treatments might I need?

Some people with a carotid bruit need treatment to lower their risk of a TIA or stroke. The goal of treatment is to improve blood flow through your carotid arteries.

Medications are often the first line of defense, especially if your carotid arteries aren’t severely narrowed. Depending on your condition, your provider may recommend one or more of the following medications:

• Blood pressure medication.
• Cholesterol-lowering medication.

Lifestyle changes can also play an important role. You can slow down the buildup of plaque in your arteries by taking these steps:

• Avoid smoking and all tobacco products. Tobacco harms your blood vessels and raises your risk for many different cardiovascular diseases. Ask your provider for resources to help you quit.
• Eat a heart-healthy diet. A heart-healthy diet involves limiting your intake of saturated fat, sodium and sugar. Plus, avoid red meat and instead choose lean chicken, turkey or fish.
• Exercise regularly. Start slow, and gradually work up to 150 minutes of moderate-intensity exercise per week. Check with your provider about what’s safe for you before starting a new exercise plan.

If your carotid artery stenosis is more severe, you may need a surgery or procedure. These include:

• Carotid endarterectomy: This is a surgery that removes plaque from your carotid artery.
• Carotid angioplasty and stenting: This is a procedure that uses a device called a stent to open up your carotid artery.

Not everyone with a carotid bruit has blockages or needs treatment. Talk with your provider to learn more about what your carotid bruit means for you.

A note from Cleveland Clinic

If your healthcare provider mentions a carotid bruit, don’t panic. It doesn’t necessarily mean you’re in danger. It’s simply one sign of many that your provider can use to check the health of your arteries. So, talk with your provider to learn more. Also, ask about your risk factors for atherosclerosis and how you can lower them.