To the Editor.
— In their recent article,1 Dr Sauvé and colleagues discuss the relationship between high-grade stenosis and carotid bruit, stating, "Unfortunately, however, this relation is not strong enough for the clinician to be able to use the presence of a bruit to rule in, or the absence of a bruit to rule out, high-grade carotid stenosis." This is an erroneous statement. Clinicians understand that some patients with high-grade stenosis do not have a carotid bruit. However, most competent neurologists who diagnose and treat vascular disease of the brain are aware that a carotid bruit extending into diastole indicates a high degree of stenosis in the carotid artery. The examiner cannot differentiate whether the high-grade stenosis is in the external carotid system or the internal carotid system, but most often it is in the latter system.The misleading statement in this article will reduce the use of carotid
Lubic LG. Detection of Carotid Stenosis by Physicial Examination. JAMA. 1994;271(24):1908. doi:10.1001/jama.1994.03510480032027