BlueCross BlueShield of Tennessee Medical Policy Manual

Ultrasonographic Measurements of Carotid Intima-Medial Thickness (CIMT) as an Assessment of Subclinical Atherosclerosis

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

IMPORTANT REMINDERS

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 patient outcomes and no specific guidance on how measurements of CIMT should be incorporated into risk assessment and risk management.

SOURCES 

American College of Cardiology/American Heart Association. (2013). 2013 ACC/AHA guideline on the assessment of cardiovascular risk. Retrieved March 30, 2017 from http://www.onlinejacc.org/content/accj/63/25_Part_B/2935.full.pdf.

Baber, U., Mehran, R., Sartori, S., Schoos, M., Sillesen, H., Muntendam, P., et al. (2015). Prevalence, impact, and predictive value of detecting subclinical coronary and carotid atherosclerosis in asymptomatic adults: the Biolmage study. Journal of the American College of Cardiology, 65 (11), 1065-1074. Abstract retrieved March 30, 2017 from PubMed database.

BlueCross BlueShield Association. Medical Policy Reference Manual. (1:2017). Ultrasonographic measurement of carotid intima-medial thickness as an assessment of subclinical atherosclerosis (2.02.16). Retrieved March 30, 2017 from BlueWeb. (30 articles and/or guidelines reviewed)

National Institute for Health and Care Excellence. (2008, August; last updated July 2016). Familial hypercholesterolaemia: identification and management. Retrieved March 30, 2017 from www.nice.org.uk/guidance/cg71.

Patel, J., Rifai, M., Blaha, M., Budoff, M., Post, W., Polak, J., et al. (2015). Coronary artery calcium improves risk assessment in adults with a family history of premature coronary heart disease. Results from multiethnic study of atherosclerosis.  Circulation Cardiovascular Imaging, 2015, 8:e003186. (Level 4 evidence)

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)

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). Coronary heart disease: screening using non-traditional risk factors. Retrieved March 30, 2017 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.

ORIGINAL EFFECTIVE DATE:  3/1/2004

MOST RECENT REVIEW DATE:  5/11/2017

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