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Increased intimal–medial thickness (CIMT, IMT) of the common carotid artery as assessed by ultrasound is an index of atherosclerosis, and is associated with symptomatic coronary artery disease. In addition, IMT is also predictive of cerebrovascular disease, stroke, left ventricular hypertrophy, and coronary artery calcium, ankle brachial index kidney disease. It is widely accepted that IMT is the only surrogate end point for CAD that is endorsed by clinical studies. This is evidenced by the fact that the US Food and Drug Administration recognize IMT as a valid end point in the evaluation of new drugs.

Both ultrasound and autopsy studies have found that carotid atherosclerosis correlates well with atherosclerosis elsewhere in the circulation and can be used as a marker of general atherosclerosis. Recent guidelines have given CIMT and plaque-based risk prediction a class II A recommendation.

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