DESCRIPTION
Symptoms of coronary heart disease vary from person to person and are usually related to the amount of atherosclerosis present in the vascular system, which includes the carotid arteries. The National Cholesterol Education Program (NCEP) Expert Panel has identified risk factors for coronary heart disease (CHD). These risk factors include: elevated serum levels of low-density lipoprotein (LDL) cholesterol; elevated total cholesterol levels; decreased high-density lipoprotein (HDL) cholesterol levels; a history of cigarette smoking; a history of hypertension; and a family history of premature CHD and age. However, at every level of risk factor exposure, there is substantial variation in the amount of atherosclerosis, presumably related to genetic susceptibility and the influence of other risk factors. There has been interest in identifying a technique that can measure and monitor atherosclerosis, which reflects the pathogenic endpoint of CHD risk factors.
The carotid arteries can be visualized by ultrasonography, and the ultrasonographic measurement of the carotid intima-medial thickness (CIMT) has been investigated as a technique to identify and monitor subclinical atherosclerosis. B-mode ultrasound is most commonly used to measure CIMT. The intima-medial thickness (IMT) 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 IMT 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 these two lines constitutes the IMT.
POLICY
Ultrasonographic measurements of carotid artery intima-medial thickness (CIMT) for use in the screening, diagnosis, or management of subclinical atherosclerosis is considered investigational.
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ADDITIONAL INFORMATION
Scientific literature in peer-reviewed journals regarding ultrasonographic measurement of carotid artery intima-medial thickness as a technique for identifying and monitoring subclinical atherosclerosis results in improved treatment outcomes is lacking.
Scientific literature regarding integration of this technology into risk assessment and management of subclinical atherosclerosis is also lacking.
SOURCES
BlueCross BlueShield Association. Medical Policy Reference Manual. (7:2011). Ultrasonographic measurement of carotid intima-medial thickness as an assessment of subclinical atherosclerosis (2.02.16). Retrieved August 25, 2011 from BlueWeb. (21 articles and/or guidelines reviewed)
Bots, M. L., Palmer, M. K., Dogan, S., Plantinga, Y., Raichen, J. S., Evans, G. W., et al. Intensive lipid lowering may reduce progression of carotid atherosclerosis within 12 months of treatment: The METEOR study. Journal of Internal Medicine, 265 (6), 698-707. (Level 1 Evidence - Industry sponsored)
Folsom, A. R., Kronmal, R. A., Detrano, R. C., O’Leary, D. H., Bild, D. E., Bluemke, D. A., et al. (2008). Coronary artery calcification compared with carotid intima-media thickness in the prediction of cardiovascular disease incidence: The Multi-Ethnic Study of Atherosclerosis (MESA). Archives of Internal Medicine, 168 (12), 1333-1339. (Level 1 Evidence - Industry sponsored)
Green, D., Foiles, N., Chan, C., Kang, J., Schreiner, P. J., Liu, K., et al. (2010). An association between clotting factor VII and carotid intima-media thickness: The CARDIA study. Stroke, 41 (7), 1417-1422. (Level 1 Evidence - Independent study)
Greenland, P., Alpert, J. S., Bellar, G. A., Benjamin, E. J., Budoff, M. J., Favad, Z. A., et al. (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. Circulation, 122 (25), e584-e636.
Lanktree, M. B., Hegele, R. A., Yusuf, S., & Anand, S. S. (2009). Multi-ethnic genetic association study of carotid intima-media thickness using a targeted cardiovascular SNP microarray. Stroke, 40 (10), 3179-3179. (Level 2 Evidence - Industry sponsored)
Lorenz, M.W., Markus, H.S., Bots, M.L., Rosvall, M., & Sitzer, M. (2007). Prediction of clinical cardiovascular events with carotid intima-media thickness: A systematic review and meta-analysis. Circulation, 115 (4), 459- 467.
Mookadam, F., Moustafa, S. E., Lester, S. J., & Warsame, T. (2010). Subclinical atherosclerosis: evolving role of carotid intima-media thickness. Preventive Cardiology, 13 (4), 186-197.
Paramsothy, P., Knopp, R. H., Bertoni, A. G., Blumenthal, R. S., Wasserman, B. A., Tsai, M. Y., et al. (2010). Association of combinations of lipid parameters with carotid intima-media thickness and coronary artery calcium in the MESA (Multi-Ethnic Study of Atherosclerosis). Journal of the American College of Cardiology, 56 (13), 1034-1041. (Level 1 Evidence - Independent study)
Stein, J.H., Korcarz, C.E., Hurst, R.T., Lonn, E., Kendall, C.B., Mohler, E.R., Najjar, S.S. et al. (2008). Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: A consensus statement from the American Society of Echocardiography Carotid Intima-Medial Thickness Task Force. Journal of the American Society of Echocardiography 21(2), 93-111.
U. S. Food and Drug Administration. (2010, June). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K101091. Retrieved August 26, 2011 from http://www.accessdata.fda.gov/cdrh_docs/pdf10/K101091.pdf.
U. S. Food and Drug Administration. (2011, May). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K110447. Retrieved August 26, 2011 from http://www.accessdata.fda.gov/cdrh_docs/pdf11/K110447.pdf.
U. S. Preventive Services Task Force. (2009, October). Using nontraditional risk factors in coronary heart disease risk assessment. Retrieved August 25, 2011 from http://www.uspreventiveservicestaskforce.org/uspstf/uspscoronaryhd.htm.
Winifred S. Hayes, Inc. Medical Technology Directory. (2009, July). Measurement of carotid intima-media thickness for predication of clinical vascular events. Retrieved August 26, 2011 from www.Hayesinc.com/subscribers. (77 articles and/or guidelines reviewed)
ORIGINAL EFFECTIVE DATE: 3/1/2004
MOST RECENT REVIEW DATE: 1/13/2011
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