Getting intimate with the carotid intima


We are pleased to announce the addition of the “carotid intima-media thickness” test (CIMT) to the array of non-invasive diagnostic tools available at Athletic Heart SF.

The idea behind the CIMT is simple: an ultrasound image of the carotid artery can provide information about the health of the artery itself and, more generally, about the overall health of the cardiovascular system.

The ultrasound image can identify two conditions.  First, the ultrasound can detect if there is actual plaque build-up which, if advanced, can block the flow of blood and contribute to the risk of stroke.  Fortunately, advanced plaque build-up is relatively rare.

Second, even in the absence of plaque build-up, the thickness of the vessel wall (CIMT) can give a broad indication of cardiovascular health.  The intima is the name of the inner lining of a vessel wall, and the media is the middle layer.  Both are seen in the image below as the bright thin line and the thin darker band behind it.

Ultrasound image of a carotid artery. The thin intima-media layer is indicated by the arrow.

The combined thickness of the intima and media is calculated using semi-automated software.  The thicker the intima-media layer, the higher the risk of cardiovascular problems in the future.

In a way, the information provided by the CIMT is similar to the coronary calcium scan that we discussed previously, but there are differences between the two tests.

The coronary calcium scan offers a more “black and white” result: any amount of calcium is abnormal.  When we measure the CIMT, on the other hand, we get a number (the thickness of the wall) which we have to compare to what would be expected for a normal person in the same age group, so the result is not always clear-cut.

Also, the CIMT varies depending on where in the neck it is measured and at what angle of the probe with respect to the artery.  Therefore, the results are not as easily reproducible as the results of a coronary calcium scan.

Nevertheless, there is value in obtaining an ultrasound of the carotid artery, especially in combination with a coronary calcium scan, which is our standard recommendation.  Some patients may have a normal coronary calcium scan but a high CIMT or even a carotid plaque.  Vice versa, some people with a normal CIMT can have coronary plaques and calcifications around the heart.

We think it makes good sense to use both in combination.  Both are part of a basic cardiovascular health screen service which includes a consultation and discussion of ways to optimize your heart health.  So, if heart disease is a concern, do not hesitate to contact us now!  We’d be happy to speak with you and help you decide the best way to optimize your cardiovascular health.

Best regards,

–Dr. Accad

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