Skip to main content
SpringerLink
Log in

Carotid intima-media thickness measurements: Techniques and clinical relevance

  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

Atherosclerosis is a systemic disease that is responsible for most cardiovascular events and stroke. Epidemiologic studies and intervention trials based on the incidence of acute vascular disease end points require years of follow-up, the participation of large populations, or both. As a consequence, such studies consume considerable time and financial resources. The use of surrogate markers, therefore, is of paramount relevance because it allows researchers to have reliable data in less time and from reduced populations. Intima-media thickness (IMT) measured by B-mode ultrasound is the most studied surrogate marker and has been validated by official medical agencies. In this article, we review the most important technical considerations related to its measurement and highlight issues that should be systematically addressed in IMT-related studies. In summary, the use of IMT as an end point in clinical studies is of great value, but several technical limitations might jeopardize its interpretation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Espeland MA, O’Leary DH, Terry JG, et al.: Carotid intimal-media thickness as a surrogate for cardiovascular disease events in trials of HMG-CoA reductase inhibitors. Curr Control Trials Cardiovasc Med 2005, 6:3

    Article  PubMed  Google Scholar 

  2. Hurst RT, Ng DW, Kendall C, Khandheria B: Clinical use of carotid intima-media thickness: review of the literature. J Am Soc Echocardiogr 2007, 20:907–914.

    Article  PubMed  Google Scholar 

  3. Pignoli P, Tremoli E, Poli A, et al.: Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging. Circulation 1986, 74:1399–1406.

    PubMed  CAS  Google Scholar 

  4. Wong M, Edelstein J, Wollman J, Bond MG: Ultrasonic-pathological comparison of the human arterial wall. Verification of intima-media thickness. Arterioscler Thromb 1993, 13:482–486.

    PubMed  CAS  Google Scholar 

  5. Gamble G, Beaumont B, Smith H, et al.: B-mode ultrasound images of the carotid artery wall: correlation of ultrasound with histological measurements. Atherosclerosis 1993, 102:163–173.

    Article  PubMed  CAS  Google Scholar 

  6. Touboul PJ, Hernández-Hernández R, Küçükolu S, et al.; PARC-AALA Investigators: Carotid artery intima media thickness, plaque and Framingham cardiovascular score in Asia, Africa/Middle East and Latin America: the PARC-AALA study. Int J Cardiovasc Imaging 2007, 23:557–567.

    Article  PubMed  Google Scholar 

  7. O’Leary DH, Polak JF, Kronmal RA, et al.: Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med 1999, 340:14–22.

    Article  PubMed  CAS  Google Scholar 

  8. Lorenz MW, Markus HS, Bots ML, et al.: Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation 2007, 115:459–467.

    Article  PubMed  Google Scholar 

  9. Granér M, Varpula M, Kahri J, et al.: Association of carotid intima-media thickness with angiographic severity and extent of coronary artery disease. Am J Cardiol 2006, 97:624–629.

    Article  PubMed  Google Scholar 

  10. Amato M, Montorsi P, Ravani A, et al.: Carotid intimamedia thickness by B-mode ultrasound as surrogate of coronary atherosclerosis: correlation with quantitative coronary angiography and coronary intravascular ultrasound findings. Eur Heart J 2007, 28:2094–2101.

    Article  PubMed  Google Scholar 

  11. Touboul PJ, Hennerici MG, Meairs S, et al.: Mannheim carotid intima-media thickness consensus (2004–2006). An update on behalf of the Advisory Board of the 3rd and 4th Watching the Risk Symposium, 13th and 15th European Stroke Conferences, Mannheim, Germany, 2004, and Brussels, Belgium, 2006. Cerebrovasc Dis 2007, 23:75–80.

    Article  PubMed  Google Scholar 

  12. Stein JH, Korcarz CE, Hurst RT, et al.; American Society of Echocardiography: Carotid intima-media thickness. 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-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr 2008, 21:93–111.

    Article  PubMed  Google Scholar 

  13. Naghavi M, Falk E, Hecht HS, et al.; SHAPE Task Force: From vulnerable plaque to vulnerable patient—Part III: executive summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force report. Am J Cardiol 2006, 98:2H–15H.

    Article  PubMed  Google Scholar 

  14. Robson J, Boomla K, Hart B, Feder G: Estimating cardiovascular risk for primary prevention: outstanding questions for primary care. BMJ 2000, 320:702e–704e.

    Article  Google Scholar 

  15. Price JF, Tzoulaki I, Lee AJ, Fowkes FG: Ankle brachial index and intima media thickness predict cardiovascular events similarly and increased prediction when combined. J Clin Epidemiol 2007, 60:1067–1075.

    Article  PubMed  Google Scholar 

  16. Potter K, Green DJ, Reed CJ, et al.: Carotid intima-medial thickness measured on multiple ultrasound frames: evaluation of a DICOM-based software system. Cardiovasc Ultrasound 2007, 5:29.

    Article  PubMed  Google Scholar 

  17. Wikstrand J: Methodological considerations of ultrasound measurement of carotid artery intima-media thickness and lumen diameter. Clin Physiol Funct Imaging 2007, 27:341–345.

    Article  PubMed  Google Scholar 

  18. Macioch JE, Katsamakis CD, Robin J, et al.: Effect of contrast enhancement on measurement of carotid artery intimal medial thickness. Vasc Med 2004, 9:7–12.

    Article  PubMed  Google Scholar 

  19. Potter K, Reed CJ, Green DJ, et al.: Ultrasound settings significantly alter arterial lumen and wall thickness measurements. Cardiovasc Ultrasound 2008, 6:6.

    Article  PubMed  Google Scholar 

  20. Bots ML, Evans GW, Riley WA, Grobbee DE: Carotid intima-media thickness measurements in intervention studies: design options, progression rates, and sample size considerations: a point of view. Stroke 2003, 34:2985–2994.

    Article  PubMed  Google Scholar 

  21. Kastelein JJ, van Leuven SI, Burgess L, et al.; RADIANCE 1 Investigators: Effect of torcetrapib on carotid atherosclerosis in familial hypercholesterolemia. N Engl J Med 2007, 356:1620–1630.

    Article  PubMed  CAS  Google Scholar 

  22. Bots ML, Visseren FL, Evans GW, et al.; RADIANCE 2 Investigators: Torcetrapib and carotid intima-media thickness in mixed dyslipidaemia (RADIANCE 2 study): a randomised, double-blind trial. Lancet 2007, 370:153–160.

    Article  PubMed  CAS  Google Scholar 

  23. Mazzone T, Meyer PM, Feinstein SB, et al.: Effect of pioglitazone compared with glimepiride on carotid intima-media thickness in type 2 diabetes: a randomized trial. JAMA 2006, 296:2572–2581.

    Article  PubMed  CAS  Google Scholar 

  24. Crouse JR 3rd, Raichlen JS, Riley WA, et al.; METEOR Study Group: Effect of rosuvastatin on progression of carotid intima-media thickness in low-risk individuals with subclinical atherosclerosis: the METEOR trial. JAMA 2007, 297:1344–1353.

    Article  PubMed  CAS  Google Scholar 

  25. Taylor AJ, Lee HJ, Sullenberger LE: The effect of 24 months of combination statin and extended-release niacin on carotid intima-media thickness: ARBITER 3. Curr Med Res Opin 2006, 22:2243–2250.

    Article  PubMed  CAS  Google Scholar 

  26. Devine PJ, Turco MA, Taylor AJ: Design and rationale of the ARBITER 6 trial (ARterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol)-6-HDL and LDL Treatment Strategies in Atherosclerosis (HALTS). Cardiovasc Drugs Ther 2007, 21:221–225.

    Article  PubMed  CAS  Google Scholar 

  27. Bots ML, Evans GW, Riley W, et al.; OPAL Investigators: The effect of tibolone and continuous combined conjugated equine oestrogens plus medroxyprogesterone acetate on progression of carotid intima-media thickness: the Osteoporosis Prevention and Arterial effects of tiboLone (OPAL) study. Eur Heart J 2006, 27:746–755.

    Article  PubMed  CAS  Google Scholar 

  28. Nanayakkara PW, van Guldener C, Wee PM, et al.: Effect of a treatment strategy consisting of pravastatin, vitamin E, and homocysteine lowering on carotid intima-media thickness, endothelial function, and renal function in patients with mild to moderate chronic kidney disease: results from the Anti-Oxidant Therapy in Chronic Renal Insufficiency (ATIC) Study. Arch Intern Med 2007, 167:1262–1270.

    Article  PubMed  CAS  Google Scholar 

  29. Mörtsell D, Malmqvist K, Held C, Kahan T: Irbesartan reduces common carotid artery intima-media thickness in hypertensive patients when compared with atenolol: the Swedish Irbesartan Left Ventricular Hypertrophy Investigation versus Atenolol (SILVHIA) study. J Intern Med 2007, 261:472–479.

    Article  PubMed  Google Scholar 

  30. Yamasaki Y, Kim YS, Kawamori R: Rationale and protocol of a trial for prevention of diabetic atherosclerosis by using antiplatelet drugs: study of Diabetic Atherosclerosis Prevention by Cilostazol (DAPC study). Cardiovasc Diabetol 2006, 5:16.

    Article  PubMed  Google Scholar 

  31. Colacurci N, Fornaro F, Cobellis L, et al.: Raloxifene slows down the progression of intima-media thickness in postmenopausal women. Menopause 2007, 14:879–884.

    Article  PubMed  Google Scholar 

  32. Nakamura Y, Ueno Y, Tamaki S, et al.: Fish consumption and early atherosclerosis in middle-aged men. Metabolism 2007, 56:1060–1064.

    Article  PubMed  CAS  Google Scholar 

  33. Kastelein JJ, Akdim F, Stroes ES, et al.; ENHANCE Investigators. Simvastatin with or without ezetimibe in familial hypercholesterolemia. N Engl J Med 2008, 358:1431–1443.

    Article  PubMed  CAS  Google Scholar 

  34. Howard BV, Roman MJ, Devereux RB, et al.: Effect of lower targets for blood pressure and LDL cholesterol on atherosclerosis in diabetes: the SANDS randomized trial. JAMA 2008, 299:1678–1689.

    Article  PubMed  CAS  Google Scholar 

  35. Spring S, Simon R, van der Loo B, et al.: High-dose atorvastatin in peripheral arterial disease (PAD): effect on endothelial function, intima-media-thickness and local progression of PAD. An open randomized controlled pilot trial. Thromb Haemost 2008, 99:182–189.

    PubMed  CAS  Google Scholar 

  36. Stocker DJ, Taylor AJ, Langley RW, et al.: A randomized trial of the effects of rosiglitazone and metformin on inflammation and subclinical atherosclerosis in patients with type 2 diabetes. Am Heart J 2007, 153:e1–e6.

    Article  PubMed  Google Scholar 

  37. Hedblad B, Zambanini A, Nilsson P, et al.: Rosiglitazone and carotid IMT progression rate in a mixed cohort of patients with type 2 diabetes and the insulin resistance syndrome: main results from the Rosiglitazone Atherosclerosis Study. J Intern Med 2007, 261:293–305.

    Article  PubMed  CAS  Google Scholar 

  38. Ariff B, Zambanini A, Vamadeva S, et al.: Candesartan-and atenolol-based treatments induce different patterns of carotid artery and left ventricular remodeling in hypertension. Stroke 2006, 37:2381–2384.

    Article  PubMed  CAS  Google Scholar 

  39. Ichihara A, Kaneshiro Y, Sakoda M, et al.: Add-on amlodipine improves arterial function and structure in hypertensive patients treated with an angiotensin receptor blocker. J Cardiovasc Pharmacol 2007, 49:161–166.

    Article  PubMed  CAS  Google Scholar 

  40. Hodis HN, Mack WJ, Zheng L, et al.: Effect of peroxisome proliferator-activated receptor gamma agonist treatment on subclinical atherosclerosis in patients with insulin-requiring type 2 diabetes. Diabetes Care 2006, 29:1545–1553.

    Article  PubMed  CAS  Google Scholar 

  41. Mita T, Watada H, Shimizu T, et al.: Nateglinide reduces carotid intima-media thickening in type 2 diabetic patients under good glycemic control. Arterioscler Thromb Vasc Biol 2007, 27:2456–2462.

    Article  PubMed  CAS  Google Scholar 

  42. Drager LE, Bortolotto LA, Figueiredo AC, et al.: Effects of continuous positive airway pressure on early signs of atherosclerosis in obstructive sleep apnea. Am J Respir Crit Care Med 2007, 176:706–712.

    Article  PubMed  CAS  Google Scholar 

  43. Vianna AC, Mocelin AJ, Matsuo T, et al.: Uremic hyperhomocysteinemia: a randomized trial of folate treatment for the prevention of cardiovascular events. Hemodial Int 2007, 11:210–216.

    Article  PubMed  Google Scholar 

  44. Fernández-Miranda C, Yebra M, Aranda JL, et al.: Effect of folic acid treatment on carotid intima-media thickness of patients with coronary disease. Int J Cardiol 2007, 118:345–349.

    Article  PubMed  Google Scholar 

  45. Zhu S, Su G, Meng QH: Inhibitory effects of micronized fenofibrate on carotid atherosclerosis in patients with essential hypertension. Clin Chem 2006, 52:2036–2042.

    Article  PubMed  CAS  Google Scholar 

  46. O’Leary DH, Polak JF, Kronmal RA, et al.: Thickening of the carotid wall. A marker for atherosclerosis in the elderly? Cardiovascular Health Study Collaborative Research Group. Stroke 1996, 27:224–231.

    PubMed  CAS  Google Scholar 

  47. Gonzalez J, Wood JC, Dorey FJ, et al.: Reproducibility of carotid intima-media thickness measurements in young adults. Radiology 2008, 247:465–471.

    Article  PubMed  Google Scholar 

  48. Mitchell CK, Aeschlimann SE, Korcarz CE: Carotid intimamedia thickness testing: technical considerations. J Am Soc Echocardiogr 2004, 17:690–692.

    Article  PubMed  Google Scholar 

  49. de Groot E, Zwinderman AH, van der Steen AF, et al.: Variance components analysis of carotid and femoral intima-media thickness measurements. REGRESS Study Group, Interuniversity Cardiology Institute of The Netherlands, Utrecht, The Netherlands. Regression Growth Evaluation Statin Study. Ultrasound Med Biol 1998, 24:825–832.

    Article  PubMed  Google Scholar 

  50. Wiegman A, Hutten BA, de Groot E, et al.: Efficacy and safety of statin therapy in children with familial hypercholesterolemia: a randomized controlled trial. JAMA 2004, 292:331–337.

    Article  PubMed  CAS  Google Scholar 

  51. de Groot E, Jukema JW, Montauban van Swijndregt AD, et al.: B-mode ultrasound assessment of pravastatin treatment effect on carotid and femoral artery walls and its correlations with coronary angiographic findings: a report of the Regression Growth Evaluation Statin Study (REGRESS). J Am Coll Cardiol 1998, 31:1561–1567.

    Article  PubMed  Google Scholar 

  52. Ainsworth CD, Blake CC, Tamayo A, et al.: 3D ultrasound measurement of change in carotid plaque volume: a tool for rapid evaluation of new therapies. Stroke 2005, 36:1904–1909

    Article  PubMed  Google Scholar 

  53. Feinstein SB: Viewpoint: Contrast ultrasound imaging of the carotid artery vasa vasorum and atherosclerotic plaque neovascularization. J Am Coll Cardiol 2006, 48:236–243.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiology Department, Echocardiography Laboratory at Rush Medical Hospital, 1653 West Congress Parkway, Jelke Building 1015, Chicago, IL, 66610, USA

    Steven B. Feinstein

Authors
  1. Blai Coll
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Steven B. Feinstein
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Steven B. Feinstein.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Coll, B., Feinstein, S.B. Carotid intima-media thickness measurements: Techniques and clinical relevance. Curr Atheroscler Rep 10, 444–450 (2008). https://doi.org/10.1007/s11883-008-0068-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11883-008-0068-1

Keywords

Search

Navigation