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.
Ultrasonographic measurements of carotid artery intima-medial thickness (CIMT) for use in the screening, diagnosis, or management of subclinical atherosclerosis are considered investigational.
Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g. statement.
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
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.
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.
BlueCross BlueShield Association. Evidence Positioning System. (5:2018). Ultrasonographic measurement of carotid intima-medial thickness as an assessment of subclinical atherosclerosis (2.02.16). Retrieved February 14, 2019 from https://www.evidencepositioningsystem.com/. (33 articles and/or guidelines reviewed)
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.
National Institute for Health and Care Excellence. (2008, August; last updated November 2017). Familial hypercholesterolaemia: identification and management. Retrieved March 30, 2017 from www.nice.org.uk.
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, 8, e003186. DOI: 10.1161/CIRCIMAGING.115.003186. (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.
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.
U. S. Preventive Services Task Force. (2014, September). Screening for asymptomatic carotid artery stenosis: U.S. preventive services task force recommendation statement. 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: 3/28/2019
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
This document has been classified as public information.