BlueCross BlueShield of Tennessee Medical Policy Manual

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


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.




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

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 (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

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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 

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

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

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.




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