Appropriate use criteria for carotid intima media thickness testing

The Society of Atherosclerosis Imaging and Prevention, in collaboration with the International Atherosclerosis Society, conducted an appropriate use review of common clinical scenarios where carotid intima media thickness testing may be considered. The indications for this review were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Thirty-three clinical scenarios were developed by a writing committee and scored by a separate technical panel on a scale of 1-9 to designate appropriate use, inappropriate use, or uncertain use. Clinical scenarios included the clinical application of CIMT for risk assessment in the absence of known coronary heart disease, risk assessment in patients with known CHD, and serial CIMT imaging for monitoring of CHD risk status. Appropriate indications were largely clustered within the detection of CHD risk among intermediate risk patients, metabolic syndrome, and older patients. There were no appropriate indications for serial testing. Inappropriate indications generally were seen among use of CIMT in low risk patients, and high risk patients. This document is intended to provide a practical guide to clinicians and promote optimal use of testing which includes both the avoidance of under and over testing. It is intended that these criteria will be updated as the evidence on CIMT imaging continues to evolve.