# Carotid Artery Ultrasound and Heart Risk: Is This Simple, Painless Test Still Worthwhile?

Carotid artery ultrasound is a safe, painless imaging test that lets doctors see the walls of the carotid arteries—the main blood vessels in the neck that supply blood to the brain—to check for early signs of atherosclerosis (hardening and narrowing of the arteries). This review article examines whether measuring carotid intima-media thickness (IMT), a key ultrasound measurement, is still valuable for predicting heart attacks and strokes, especially after 2013 guidelines discouraged its routine use. The authors conclude that while measuring the common carotid artery IMT alone has limitations, combining IMT with plaque detection—including plaque size, burden, and tissue characteristics—using modern 3D ultrasound offers significantly better risk prediction. Blood flow measurements also show promise, but more research is needed before they can be widely used in everyday clinical practice.

# Carotid Artery Ultrasound and Heart Risk: Is This Simple, Painless Test Still Worthwhile?

## Table of Contents

- Key Points
- Why This Research Matters
- Understanding Carotid Ultrasound and Intima-Media Thickness (IMT)
- The 2013 Guidelines That Changed Clinical Practice
- How This Review Was Conducted
- Key Finding: Which Part of the Carotid Artery Is Best to Measure?
- Key Finding: IMT vs. Plaque—Which Predicts Heart Risk Better?
- Understanding Carotid Plaque: Types, Tissue, and Burden
- Combining Ultrasound with Other Heart Risk Biomarkers
- Measuring Blood Flow in the Carotid Artery
- What This Means for Patients
- Limitations: What This Review Could Not Prove
- Recommendations and Future Directions
- Frequently Asked Questions
- Source Information

## Key Points

- Carotid ultrasound is safe, painless, and can detect early atherosclerosis, but measuring IMT alone is no longer routinely recommended.
- Carotid plaque is a stronger predictor of cardiovascular risk than IMT alone; checking for plaque presence and characteristics adds value.
- The common carotid artery is easiest to measure reliably, but bulb and internal carotid measurements predict risk better, though harder to obtain.
- Blood flow velocity, especially end-diastolic velocity, is associated with future events and may improve risk prediction, but needs more research.
- Combining carotid ultrasound with other biomarkers like hs-CRP or coronary calcium score gives a more complete risk assessment.

## Why This Research Matters

Heart disease and stroke remain leading causes of death worldwide. Detecting atherosclerosis early—before it causes a heart attack or stroke—is one of the most important goals of preventive medicine. Doctors have several tools to assess cardiovascular risk, including blood pressure measurements, cholesterol tests, and risk calculators. But these tools don't always tell the whole story.

Carotid ultrasound offers something different: a direct, real-time look at the actual artery wall. It's non-invasive (no needles or surgery), painless, relatively inexpensive, and involves no radiation. That makes it an attractive option for screening. But is it actually useful enough to change treatment decisions? That question became highly controversial in 2013, when major American guidelines suddenly downgraded one of its key measurements. This review article, written by Korean cardiologists Dr. Gee-Hee Kim and Dr. Ho-Joong Youn, takes a detailed look at the evidence both for and against the continued use of carotid ultrasound.

## Understanding Carotid Ultrasound and Intima-Media Thickness (IMT)

Your carotid arteries have four segments: the common carotid artery (CCA), the bifurcation (also called the bulb, where the artery splits), the external carotid artery, and the internal carotid artery (ICA), which carries blood to the brain. When doctors perform a carotid ultrasound, they can measure several things, including the thickness of the artery wall, the presence of plaque, blood flow velocity, and arterial diameter.

The key measurement is called **intima-media thickness (IMT)**. The artery wall has three layers: the intima (innermost layer), the media (middle muscular layer), and the adventitia (outer layer). On a B-mode ultrasound image, the arterial wall appears as a **"double-line pattern"**—the inner line represents the intima surface, and the outer line represents the media. Carotid IMT is defined as the distance between the luminal border of the intima and the outer border of the media on the far wall of the artery.

Think of it like measuring the thickness of a pipe wall. Just as a pipe wall thickens with rust and buildup, the artery wall thickens as atherosclerosis develops. The beauty of ultrasound is that it can measure this thickening non-invasively, using sound waves that bounce off the tissue to create an image.

Multiple large studies have shown that carotid IMT and the presence of plaque predict future cardiovascular events (heart attacks, strokes, and related deaths). Even in people considered low-risk, screening with IMT and plaque assessment can detect subclinical atherosclerosis—meaning the disease is present but hasn't caused symptoms yet.

## The 2013 Guidelines That Changed Clinical Practice

In 2013, the **American College of Cardiology/American Heart Association (ACC/AHA)** released new guidelines for cardiovascular risk assessment. These guidelines designated carotid IMT as **Class III evidence**, meaning it was **not recommended** for routine use in clinical practice as a measurement of risk for a first atherosclerotic cardiovascular disease (ASCVD) event. This was a major shift—overnight, a widely used measurement was effectively de-prioritized.

The announcement sparked considerable debate among cardiologists and ultrasound specialists. Dr. Naqvi and colleagues later argued that the controversy over carotid IMT's usefulness stems largely from the **lack of a uniform methodology** across studies. Different research groups measured IMT in different artery segments, used different definitions of plaque, and applied different statistical models—making it hard to compare results and draw consistent conclusions.

This review article was written to evaluate what researchers have learned since that 2013 guideline was announced, and to assess whether carotid ultrasound still deserves a place in clinical practice.

## How This Review Was Conducted

This is a **review article**, not a new clinical trial. The authors—Dr. Gee-Hee Kim from St. Vincent's Hospital in Suwon and Dr. Ho-Joong Youn from Seoul St. Mary's Hospital, both affiliated with The Catholic University of Korea—systematically examined studies published after the 2013 ACC/AHA guideline announcement. Their goal was to evaluate the evidence on carotid IMT for ASCVD risk prediction and estimation in specific conditions.

The review covers several categories of research:

- Studies comparing IMT measurements at different carotid artery segments (CCA, bulb, and ICA)
- Studies comparing IMT vs. plaque as predictors of cardiovascular events
- Studies using separate measurements of the intima and media layers
- Studies using hemodynamic (blood flow) parameters such as peak-systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI)
- Studies combining carotid ultrasound with other biomarkers like high-sensitivity C-reactive protein (hs-CRP), coronary artery calcium score (CACS), and ankle-brachial index (ABI)

## Key Finding: Which Part of the Carotid Artery Is Best to Measure?

One of the most important practical questions is which segment of the carotid artery to measure. Not all segments are equally easy to image or equally informative. The data reveal a clear trade-off between reliability and predictive power.

Regarding image quality and reliability, two large studies provide striking numbers:

- In the **Atherosclerosis Risk in Communities (ARIC) study**, 91.4% of CCA-IMT segments could be adequately imaged, compared with only 77.3% of bulb IMT segments and just 48.6% of ICA-IMT segments.
- In the **Rotterdam study**, carotid IMT measurements were possible in 96% of CCA-IMT segments, compared with 64% of bulb-IMT segments and only 31% of ICA-IMT segments.

Clearly, the common carotid artery is the easiest and most reliable segment to measure. The ICA is difficult to image adequately, which limits its usefulness in routine practice. For accuracy and best reproducibility, the CCA far wall IMT measurement has been validated as representing the true thickness of the vessel wall. The development of automated edge-detection programs (software that automatically identifies the artery wall boundaries) has increased measurement speed and reduced variability compared with older manual techniques.

However, there's a catch. When it comes to predicting risk, the less reliable segments may actually be more informative. Studies found that including the carotid bulb and ICA-IMT measurements made them **better predictors of both cardiac risk and stroke risk** than CCA-IMT alone. This creates a clinical dilemma: the easiest measurement to obtain (CCA-IMT) is the least predictive, while the more predictive measurements (bulb and ICA) are harder to obtain reliably.

### Separate Measurements of Intima and Media: A More Detailed Look

Carotid IMT is actually the sum of two separate layers: the **intima thickness (IT)** and the **media thickness (MT)**. Instead of measuring them together, some researchers have explored measuring each layer separately. This matters because the two layers respond differently to different risk factors.

An animal study using a 40 MHz ultrasound probe found that the carotid high-echogenic intimal thickening (HEIT) correlates closely with the histological (microscopic) intima thickness. This means ultrasound can accurately measure the intima layer when high-frequency probes are used.

The research shows that:

-
**Early atherosclerosis** primarily affects the intima layer (IT)
- Thus, IT can be a useful parameter for **early detection**, predicting progression, and evaluating atherosclerosis
-
**High blood pressure (hypertension)** increases the media layer (MT), consistent with medial hypertrophy (thickening of the muscular layer)
- Separate measurement of IT and MT is useful for evaluating how different atherosclerotic risk factors affect different parts of the arterial wall

However, there are major technical limitations. The theoretical axial resolution of a standard 7 MHz ultrasound transducer is approximately 0.3 mm. High-frequency transducers (about 11–15 MHz) can achieve a pixel resolution of approximately 0.1 to 0.2 mm. The problem? The mean intima thickness is approximately **0.2 mm**—which means it can be intermittently or inadequately measured even with high-frequency transducers. If the IMT complex is thinner than 0.3 mm, the leading edges of the two echo interfaces (from the far wall intima and adventitia) cannot be separated, and measurement of the intima-media complex is not possible using a standard 7 MHz transducer.

Another critical limitation: the annual change of carotid IMT in the general population is approximately **0.01 to 0.04 mm per year** (and similar in patients with disease). This rate of change is lower than the current resolution of ultrasound. In plain terms, the yearly thickening of the artery wall is smaller than the smallest measurement the machine can reliably detect. Therefore, it is essentially impossible to analyze carotid IMT changes over a short period—like monitoring a patient for a year or two to see if treatment is working.

The authors note that a more detailed and elaborate technique needs to be developed. If separate measurement of IT and MT can be perfected, it could play an important role in assessing atherosclerosis and arterial wall changes according to various risk factors, such as metabolic syndrome.

## Key Finding: IMT vs. Plaque—Which Predicts Heart Risk Better?

A meta-analysis of 14 population-based studies evaluated carotid IMT and plaque for cardiovascular risk prediction. The findings were nuanced. When CCA-IMT alone was added to the Framingham Risk Score (a widely used risk calculator), it was associated with only a small improvement in 10-year risk prediction of first-time heart attack or stroke—an improvement the researchers said is **"unlikely to be of clinical importance."**

However, when the carotid bulb and ICA-IMT were included, the measurements became better predictors of both cardiac risk and stroke risk. And critically, **carotid plaque appears to be a more powerful predictor of cardiovascular risk than carotid IMT alone.** This is one of the most important takeaways from this review: if you have to choose between measuring IMT or looking for plaque, plaque wins.

The authors emphasize that many previous studies showed discrepant results because they differed widely in methodology:

- Which segments were evaluated (CCA, ICA, or the carotid bulb)
- The type of measurements used (mean or maximum of single measurements, mean of the mean, or mean of the maximum for multiple measurements)
- Whether plaques were included in the IMT measurement
- Whether statistical models were adjusted or unadjusted
- Whether the study looked at risk association vs. risk prediction
- The arbitrary cutoff points used for IMT and plaque

After the 2013 ACC/AHA guideline, the ARIC study reported that coronary heart disease (CHD) risk prediction can be improved by adding all carotid artery segments (A-CIMT) including the presence of plaque, or CCA-IMT plus plaque information, to traditional risk factors—compared with CCA-IMT alone. Since measuring CCA-IMT is easier and more reliable than measuring all segments, the researchers concluded that **evaluating the carotid artery for plaque presence and measuring CCA-IMT together provide a good parameter for CHD risk prediction.**

### What the Studies Show in Specific Patient Groups

The review highlights how the value of carotid ultrasound varies depending on the patient population:

-
**Asymptomatic high-risk patients:** A recent study found carotid plaque was more useful as an additive predictive factor for primary prevention of ASCVD than CCA-IMT alone.
-
**Heart attack survivors:** CCA-IMT and carotid plaque were both useful prognostic parameters for predicting long-term future cardiovascular events in patients with well-treated ST-elevation myocardial infarction (STEMI). The value of CCA-IMT in predicting events appeared to be clinically important beyond traditional risk factors in this relatively low-risk post-heart-attack population.
-
**Patients with one or more traditional risk factors:** Carotid plaque was more useful as an additive predictive factor for both primary and secondary prevention of ASCVD than CCA-IMT alone.
-
**Younger patients with hypertension:** In a small study, no significant differences in clinical outcomes from cardiovascular events (including death, heart attack, and stroke) were observed between the highest and lowest CCA-IMT values (based on inter-quartile range) in younger subjects (males under 45 years and females under 55 years).
-
**Young Iranian population:** Another study found that, within a relatively young population without a history of cardiovascular events, thicker carotid IMT did not associate with several modifiable cardiovascular risk factors.
-
**Elderly hypertensive patients (60+):** Interestingly, only calcified carotid plaques (except for mean A-CIMT) predicted mortality and cardiovascular outcomes above other traditional risk factors such as age, sex, and hypertensive status.

These findings suggest that the usefulness of carotid IMT measurement is not uniform across all patients—it depends heavily on age, risk profile, and what other risk factors are present.

## Understanding Carotid Plaque: Types, Tissue, and Burden

Carotid plaque is identified on ultrasound as an echoic (bright) focal projection, or as focal wall thickening that is at least 50% greater than that of the surrounding vessel wall, or as a focal region with carotid IMT greater than 1.5 mm that protrudes into the lumen and is distinct from the adjacent boundary. Other signs include shadowing in the wall texture, roughness, and inconsistency in the visualization of structural boundaries together with bright echogenicity.

Previous studies have taken different approaches to analyzing plaques. Some simply record the **presence or absence** of plaque. Others grade the **size or burden** (mild, moderate, or severe), count the **number of visible plaques** (none, single, or multiple), or assess the **composition and tissue characteristics** (echolucent or calcified).

One key limitation: reliable characterization of plaque tissue content and features suggestive of plaque instability (like ulceration or a thin fibrous cap) using standard carotid ultrasound is not yet possible. This has led researchers to explore other imaging methods:

-
**PET/CT scanning:** Using positron emission tomography-computerized tomography, researchers found that echolucent plaque (plaque that appears dark on ultrasound) has greater F-18 FDG uptake than calcified plaque or no plaque. This increased uptake seems to imply a high inflammatory state—inflammation being a key driver of plaque rupture.
-
**Spiral CT imaging:** Calcified regions of carotid plaque appear as white radiodense areas, contrasting with the remaining non-calcified regions of the plaque and lumen.
-
**High-resolution MRI:** This imaging technique revealed that **71% of carotid plaques contain a lipid core**—a finding that might provide evidence supporting more aggressive cholesterol-lowering therapy in affected patients.
-
**Computer-assisted pixel distribution analysis:** This new technique can analyze the ultrasound characteristics of complex plaques and accurately quantify intraplaque hemorrhage, fibromuscular tissue, calcium, and lipid content.

The emergence of **3-dimensional (3D) ultrasound** represents another major advance. With 3D ultrasound, plaque areas from all cross-sectional images in the entire image sequence are summed to calculate the **plaque burden**—a measure of total plaque volume. This allows more accurate quantification of plaque volume or area than traditional 2D imaging.

The authors stress that not only the presence or absence of plaque, but also the **characteristics of plaque and plaque burden**, can be evaluated with regard to prognosis of cardiovascular events and implications for risk. Echolucent (soft, dark) plaques tend to be lipid-rich, which may indicate higher risk and the need for more aggressive therapy. Echogenic (bright) plaques have a higher content of dense fibrous tissue and calcification.

## Combining Ultrasound with Other Heart Risk Biomarkers

Biomarkers are measurable indicators of biological conditions—they help doctors detect high-risk individuals, diagnose disease promptly and accurately, and evaluate prognosis and treatment outcomes. The review examines how carotid IMT compares with other established biomarkers:

**Coronary artery calcium score (CACS):** This CT-based test measures calcium deposits in the coronary arteries. According to the 2013 ACC/AHA guideline, if a risk-based treatment decision is vague after quantitative traditional risk factor assessment, evaluation of one or more additional factors (family history, hs-CRP, CACS, or ABI) may be considered. The authors note that CACS, which is similar to a structural biomarker of the artery, is useful for diagnosis and as a surrogate marker of ASCVD compared with CCA-IMT or plaque. Carotid plaque and increased carotid IMT are associated with the presence and degree of coronary calcification and disease.

**Ankle-brachial index (ABI):** This is a functional biomarker that compares blood pressure in the ankles vs. the arms. In one retrospective study, patients with greater mean CCA-IMT (≥0.9 mm) or lower ABI (<0.9) had significantly higher complexity and presence of coronary artery disease (CAD). The combination of CCA-IMT and ABI together provided additive information for predicting the severity and presence of CAD.

**High-sensitivity C-reactive protein (hs-CRP):** This is a serological biomarker of inflammation. Another study found that hs-CRP levels and carotid plaque characteristics correlated closely with the severity of CAD. This suggests that combining a blood test for inflammation with an ultrasound look at plaque can give a more complete picture of a patient's risk.

## Measuring Blood Flow in the Carotid Artery

Beyond measuring artery wall thickness, carotid ultrasound can measure **hemodynamic parameters**—how blood actually flows through the artery. The key measurements include:

-
**Peak-systolic velocity (PSV):** The maximum blood flow speed during a heartbeat
-
**End-diastolic velocity (EDV):** The blood flow speed at the end of the heartbeat
-
**Resistive index (RI):** Calculated as (PSV − EDV) / PSV, this reflects the resistance to blood flow in the artery

The evidence for using these measurements is growing:

- In a case-control study, stroke patients in both the acute (immediate) and chronic stable phase appeared to have lower common carotid blood flow (CBF) velocity and higher resistive index than non-stroke patients—and this was **independent of carotid atherosclerosis**.
- In a Taiwanese population at low risk for atherosclerosis, CCA-IMT and EDV could jointly predict the risk of future ischemic stroke events. Notably, the **EDV value was more strongly associated with ischemic stroke than was CCA-IMT**.
- In a prospective study, carotid flow velocity (CFV) was significantly associated with the development of cardiovascular disease during a median follow-up time of **12.8 years**. CBF velocity, particularly EDV, also **improved the risk prediction** of cardiovascular disease.
- In a study of **1,119 Korean patients** without coronary heart disease or stroke, higher RI and lower CCA-PSV and CCA-EDV (but not ICA Doppler indices) were related to future cardiovascular events.

The authors conclude that carotid flow velocity represents a subclinical atherosclerosis index and should be included in the assessment of cardiovascular disease risk.

## What This Means for Patients

For patients, the practical questions are: Should I ask my doctor for a carotid ultrasound? And if I get one, what do the results mean?

Based on this review, here's what patients should understand:

1.
**Measuring IMT alone is no longer recommended as a routine screening test.** The 2013 ACC/AHA guidelines specifically advised against using carotid IMT as a routine measurement for first-event risk assessment. The evidence supports this: CCA-IMT alone adds little to traditional risk factor-based prediction (like the Framingham Risk Score) for 10-year heart attack or stroke risk.
1.
**Looking for plaque is more valuable than measuring wall thickness.** Carotid plaque appears to be a more powerful predictor of cardiovascular risk than IMT alone. If your doctor orders a carotid ultrasound, the presence, size, number, and characteristics of any plaque are likely to be more informative than the IMT number.
1.
**If IMT is measured, the location matters.** Measurements at the carotid bulb and internal carotid artery are more useful for risk classification and prediction than CCA-IMT alone—but these segments are harder to image reliably. The CCA-IMT is the easiest to measure and the most reproducible.
1.
**Plaque characteristics provide important clues.** If imaging reveals echolucent (soft) plaque, it may be lipid-rich and indicate a higher inflammatory state, which could warrant more aggressive cholesterol-lowering therapy. Calcified (bright) plaque, particularly in elderly hypertensive patients over 60, was shown to predict mortality and cardiovascular outcomes above other risk factors.
1.
**Blood flow measurements add value.** Carotid flow velocity, especially EDV, has been independently associated with future cardiovascular events and can improve risk prediction. These measurements may become more common in clinical practice as research continues to define their role.

## Limitations: What This Review Could Not Prove

It's important to understand the limitations of both the original studies and this review:

-
**Methodological inconsistencies:** The "lack of a uniform methodology in carotid IMT studies" is a central problem. Different studies used different segments, measurement techniques, statistical models, and cutoff points, limiting the ability to compare results or pool data reliably.
-
**Technical resolution limits:** Standard 7 MHz ultrasound transducers cannot reliably separate the intima and media layers when the IMT complex is thinner than 0.3 mm. The mean intima thickness (~0.2 mm) is right at the edge of what high-frequency transducers can measure. The annual change in IMT (0.01–0.04 mm/year) is smaller than ultrasound resolution, making short-term monitoring impossible.
-
**Younger and lower-risk populations:** Several studies showed no significant predictive value for carotid IMT in younger patients. This suggests the test may be less useful in younger or lower-risk individuals.
-
**Hemodynamic parameters need more research:** While promising, the role of carotid flow velocity measurements (PSV, EDV, RI) requires validation in large multicenter studies to establish reproducibility and abnormal cutoff values.
-
**No standard cutoffs:** Abnormal cutoff values for CCA-IMT, plaque presence, and plaque size or volume—adjusted for age, race, and sex—remain to be defined.

## Recommendations and Future Directions

The authors offer several forward-looking recommendations for both clinical practice and future research:

-
**For clinicians:** Combined CCA-IMT and plaque assessment, including plaque tissue characterization and plaque burden using 3D ultrasound, appears to be better than either measurement alone for the assessment and prediction of ASCVD risk.
-
**For researchers:** Future developments in ultrasound technology should focus on separate measurements of the intima and media layers, which could evaluate the effects of different atherosclerotic risk factors (such as metabolic syndrome) on the arterial wall. The authors believe separate measurement will play an important role in evaluating subclinical atherosclerosis and arterial wall remodeling.
-
**For guideline developers:** Future guidelines should consider the roles of plaque presence, plaque burden, and hemodynamic parameters in additional risk stratification beyond carotid IMT.
-
**For treatment monitoring:** Plaque progression and regression assessed by 3D ultrasound may be a powerful method to assess the effect of therapy. Further study is needed to determine changes or remodeling of CCA-IMT and plaque after therapy or intervention.

For patients considering carotid ultrasound, the most practical takeaway is this: **don't focus on the IMT number alone.** Ask your doctor about plaque presence, plaque burden, and blood flow measurements. These provide a more complete picture of your actual cardiovascular risk. And remember—carotid ultrasound is just one piece of the puzzle. It works best when combined with traditional risk factors, blood tests like hs-CRP, and other measurements like ABI and coronary artery calcium scoring.

Carotid ultrasound remains a very useful, simple, and safe method to indirectly detect and prevent cardiovascular disease. But its full potential will only be realized as technology improves—allowing better measurement of plaque characteristics and separate intima/media layers—and as larger studies help define clear standards for how to use these measurements in everyday practice.

## Frequently Asked Questions

### What is a carotid artery ultrasound and what does it measure?

A carotid artery ultrasound is a safe, painless imaging test that uses sound waves to look at the carotid arteries in your neck. It measures artery wall thickness, called intima-media thickness (IMT), checks for plaque, and can measure blood flow velocity. It helps detect early atherosclerosis, the hardening and narrowing of arteries that can lead to heart attack or stroke.

### Is carotid IMT measurement still recommended for heart risk screening?

The 2013 ACC/AHA guidelines no longer recommend measuring carotid IMT alone as a routine test for first heart attack or stroke risk. Adding common carotid IMT to traditional risk scores like the Framingham Risk Score only slightly improves prediction, which researchers say is unlikely to be clinically important. However, combining IMT with plaque detection may still be valuable.

### What is carotid plaque and why is it important?

Carotid plaque is a focal thickening or bright projection on the artery wall, often defined as IMT greater than 1.5 mm. It appears to be a more powerful predictor of cardiovascular risk than IMT alone. Plaque characteristics, such as being echolucent (soft and lipid-rich) or calcified, and plaque burden measured by 3D ultrasound, provide additional risk information.

### Can carotid ultrasound measure blood flow and does it help predict risk?

Yes, carotid ultrasound can measure blood flow velocity, including peak-systolic velocity, end-diastolic velocity, and resistive index. Studies show that lower blood flow velocity, especially end-diastolic velocity, is associated with future cardiovascular events and can improve risk prediction. However, more research is needed before these measurements are widely used in routine clinical practice.

### How does carotid ultrasound compare to other heart risk tests like coronary calcium score?

Coronary artery calcium score (CACS), a CT-based test, is similar to a structural biomarker and is useful for diagnosis and as a surrogate marker of cardiovascular disease compared with CCA-IMT or plaque. Carotid plaque and increased IMT are associated with coronary calcification. Combining carotid ultrasound with other biomarkers like hs-CRP or ankle-brachial index gives a more complete risk picture.

### Can carotid ultrasound be used to monitor treatment effects?

Currently, measuring IMT changes over short periods is difficult because the annual change is about 0.01 to 0.04 mm per year, which is smaller than the resolution of standard ultrasound. However, plaque progression or regression assessed by 3D ultrasound may be a powerful way to assess therapy effects, but this requires further study before routine use.

## Source Information

**Original article title:** Korea Is Carotid Artery Ultrasound Still Useful Method for Evaluation of Atherosclerosis?

**Journal:** Korean Circulation Journal, 2017;47(1):1-8

**DOI:** https://doi.org/10.4070/kcj.2016.0232

**Received:** June 13, 2016 | **Accepted:** June 30, 2016

This patient-friendly article is based on peer-reviewed research published as an open-access review article. The authors declared no financial conflicts of interest.


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