DESCRIPTION
Ultrasonographic measurement of carotid intima-media thickness (CIMT) refers to the use of B-mode ultrasound to determine the thickness of the two innermost layers of the carotid artery wall; the intima and the media. The carotid arteries can be well-visualized by ultrasonography, and ultrasonographic measurement of the carotid intima-medial thickness has been investigated as a technique to identify and monitor subclinical atherosclerosis. The intima-media thickness is measured and averaged over several sites in each carotid artery. Imaging of the far wall of each common carotid artery yields more accurate and reproducible intima-medial thickness measurements than imaging of the near wall. Two echogenic lines are produced, representing the lumen-intima interface and the media-adventitia interface. The distance between the two lines constitutes the intima-medial thickness.
POLICY
Ultrasonographic measurement of carotid artery intima-medial thickness (CIMT) for use in the screening, diagnosis, or management of subclinical atherosclerosis is considered investigational.
IMPORTANT REMINDERS
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ADDITIONAL INFORMATION
The results of the studies for carotid intima-medial thickness (CIMT) are lacking and demonstrate that the predictive value of CIMT is uncertain. In addition, the available studies do not define how the use of CIMT in clinical practice improves outcomes. There is no scientific literature that directly tests the hypothesis that measurement of CIMT results in improved health outcomes and no specific guidance on how measurements of CIMT should be incorporated into risk assessment and risk management.
SOURCES
American College of Cardiology Foundation/American Heart Association. (2010). 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Retrieved July 23, 2021 from https://professional.heart.org/.
American College of Cardiology/American Heart Association. (2013). 2013 ACC/AHA guideline on the assessment of cardiovascular risk. Retrieved March 30, 2017 from https://professional.heart.org/.
BlueCross BlueShield Association. Evidence Positioning System. (6:2023). Ultrasonographic measurement of carotid intima-medial thickness as an assessment of subclinical atherosclerosis (2.02.16). Retrieved October 3, 2023 from https://www.evidencepositioningsystem.com/. (36 articles and/or guidelines reviewed)
Bytyci, I., Shenouda, R., Wester, P., & Henein, M. (2021). Carotid atherosclerosis in predicting coronary artery disease: A systematic review and meta-analysis. Arteriosclerosis, Thrombosis, & Vascular Biology, 41 (4), e224-e237. (Level 2 evidence)
Geisel, M.H., Bauer, M., Hennig, F., Hoffman, B., Lehmann, N., Mohlenkamp, S., et al. (2017). Comparison of coronary artery calcification, carotid intima-media thickness and ankle-brachial index for predicting 10-year incident cardiovascular events in the general population. European Heart Journal, 38 (23), 1815-1822. Abstract retrieved February 18, 2019 from PubMed database.
Peters, S., den Ruijter, H., Bots, M., & Moons, K. (2012). Improvements in risk stratification for the occurrence of cardiovascular disease by imaging subclinical atherosclerosis: a systematic review. Heart, 98, 177-184. (Level 1 evidence)
Tschiderer, L., Klingenschmid, G., Seekircher, L., & Willeit, P. (2020). Carotid intima-media thickness predicts carotid plaque development: Meta-analysis of seven studies involving 9341 participants. European Journal of Clinical Investigation, 50 (4): e13217. (Level 2 evidence)
U. S. Preventive Services Task Force. (2018, July). Risk assessment for cardiovascular disease with nontraditional risk factors US preventive services task force recommendation statement. Retrieved September 27, 2022 from https://www.uspreventiveservicestaskforce.org.
U. S. Preventive Services Task Force. (2021, February). Screening for asymptomatic carotid artery stenosis: U.S. preventive services task force recommendation statement. Retrieved July 22, 2021 from https://www.uspreventiveservicestaskforce.org.
Van den Oord, S., Sijbrands, E., ten Kate, G., van Klaveren, D., van Domburg, R., van der Steen, A., & Schinkel, A. (2013). Carotid intima-media thickness for cardiovascular risk assessment: systematic review and meta-analysis. Atherosclerosis, 228 (1), 1-11. Abstract retrieved March 30, 2017 from PubMed database.
Villines, T.C., Hsu, L.., Blackshear, C., Nelson, C.R., & Griswold, M. (2017). Relation of carotid intima-media thickness to cardiovascular events in black Americans (from the Jackson Heart Study). American Journal of Cardiology, 120 (9), 1528-1532. (Level 3 evidence)
ORIGINAL EFFECTIVE DATE: 3/1/2004
MOST RECENT REVIEW DATE: 11/9/2023
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