For Physicians


The country's leading cardiologists published the Executive Summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force Report in The American Journal of Cardiology 2006;98{suppl}:2H-15H. SHAPE Guidelines recommend screening all men ages 45 - 75 and all women age 55 - 75 for vulnerable plaque unless they have no risk factors.


Read the SHAPE Task Force Report Summary.

For full details visit www.shapesociety.org.


Existing Guidelines for Cardiovascular Screening are Inadequate

  • Existing methods stratify patients according to the Framingham Risk Score.
  • More than 80% of events occur in the low and intermediate risk groups.
  • Many individuals at true high risk are not identified and appropriately treated.
  • Others, erroneously classified as high risk, are treated unnecessarily for the rest of their life.
  • Clearly, this is neither cost-effective, nor good medical practice.



A New Paradigm for the Prevention of Heart Attack and Stroke


We used to think that heart attacks and strokes occurred as plaque slowly plugged up the artery over many decades. We now know most heart attacks are caused by the rupture of vulnerable plaque in arteries that are about 50% occluded. Use CIMT testing to:

  • Accurately identify the vulnerable patient with an imaging study and treat aggressively.
  • Stop aggressive treatment of patients with minimal disease.
  • Replace traditional risk factor assessment with direct measurement of atherosclerotic plaque.

Plaque Imaging Methods:


Intravasular Ultrasound (IVUS) is the gold standard but is invasive and not readily available.


Coronary Artery Calcium Scoring (CACS) requires radiation and a 64 slice CT Scanner. It does not identify uncalcified high risk fatty plaque in younger individuals, nor can it be used to follow a patient's response to therapy. Fatty plaque may thin with treatment over time but the calcium in the plaque remains.


Magnetic Resonance Imaging (MRI) is being investigated for this purpose.


Carotid Intima-Media Thickness (CIMT) measurement uses B-mode ultrasound with EKG gating, and sophisticated edge-detection software. Studies involving over 37,000 patients have shown a 90% correlation between the common carotid artery IMT and coronary arteries. CIMT does not require radiation and can be used to follow a patient's response to therapy over time as reverse cholesterol transport shrinks the fatty plaque. It accurately identifies younger patients at high risk whose plaque has not yet calcified.


CIMT testing is cleared by the FDA and endorsed by the National Cholesterol Education Program (ATPIII), the American Heart Association (AHA), and the American College of Cardiology. It has been used in research since 1992 and has been available in clinical settings since 2002. Published studies in the most reputable journals have validated the safety and efficacy of CIMT testing, and it has been widely used in large epidemiologic trials and outcome studies as a surrogate end point for clinical events. At its annual Prevention Conference V, the AHA concluded that:


Carotid artery B-mode ultrasound imaging is a safe, noninvasive, and relatively inexpensive means of assessing subclinical atherosclerosis. The severity of carotid IMT is an independent predictor of transient cerebral ischemia, stroke, and coronary events such as MI. . . in asymptomatic persons > 45 years old, carefully performed carotid ultrasound examination with IMT measurement can add incremental information to traditional risk factor assessment.

Coastal CIMT


Coastal CIMT uses state-of-the-art high frequency B-mode ultrasound equipment with EKG gating, and ArterioVisionTM sophisticated edge-detection software. In addition to precisely measuring the inner two layers of the carotid artery where fatty plaque first develops, ArterioVisionTM compares each result to individuals of the same age and sex in a California Institute of Technology database of 15,000 people to determine the patient’s Artery Age and their lifetime risk of a heart attack. Our certified vascular technologists also screen the patient's internal carotid arteries for the presence or absence of lumenal plaque as part of the exam.


Early detection of vulnerable plaque allows the physician and patient to develop a treatment regimen that is best suited to prevent heart attack or stroke.


Learn more about ArterioVisionTM at www.i-mti.com


What do I do with the results?


Moderate High Risk: 
CIMT 50-75%
Treat all underlying risk factors, with LDL < 100. 
Repeat CIMT in 3 years.
High Risk: 
CIMT 75-95%
Treat all underlying risk factors, with LDL < 70 & HDL > 40.
Repeat CIMT in 2 years.
Very High Risk: 
CIMT > 95%
Treat all underlying risk factors with LDL < 70 & HDL > 50.
Consider cardiac evaluation &/or stress testing.
Repeat CIMT in 1 year.
Screen family members.


The Coastal CIMT Newsletter 


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Coastal CIMT
1821 Old Donation Parkway
​ Suite #2
​Virginia Beach, Virginia 23454

Phone (757) 390-4224

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