A practical protocol to measure common carotid artery intima-media thickness

objective: to describe and test a practical protocol to measure common carotid intima-media thickness that uses the combined values of two longitudinal examination angles to increase sensitivity. method: between february and september 2005, 206 patients underwent duplex scan examination of carotid vessels, and the intima-media thickness of 407 common carotids were measured in three angles: transversal, longitudinal posterolateral, and anterolateral, with three intima-media thickness measurements for each near and far wall. in addition to numbers obtained from the three angles of measurement, a fourth visual perspective was obtained by combining the intima-media thickness results of posterolateral and anterolateral longitudinal views and considering the thickest wall measurement. results: two hundred seventy (66.3%) carotid arteries had an intima-media thickness thicker than 1mm. the mean intima-media thickness values achieved by the different incidences were 1.26±0.6mm (transversal), 1.17±0.54mm (longitudinal anterolateral), and 1.18±0.58mm (longitudinal posterolateral). a significant difference in intima-media thickness measurement values was observed when the three angles of examination plus the combined positive results of both longitudinal angles were compared by anova (p=0.005). the lsd post-hoc test determined that the combined longitudinal view results were similar to the transversal views (p=0.28) and had greater intima-media thickness means than isolated anterolateral or posterolateral longitudinal views (p=0.02 and 0.05, respectively). conclusions: the protocol presented is a practical method for obtaining common carotid artery intima-media thickness measurements. the combined longitudinal posterolateral and anterolateral longitudinal views provide a more sensitive evaluation of the inner layers of the carotid walls than isolated longitudinal views.