As part of the Bale Doneen method, we use imaging tools to evaluate the health of your arteries. This allows us not only to assess cardiovascular risk but also to evaluate whether our treatment strategies are effectively stabilizing arterial disease over time. We continue to use carotid intima-media thickness (IMT) imaging annually because it is reproducible, safe and well-validated. Importantly, decades of data show that what we see in the carotid arteries of the neck generally reflects what is happening throughout the nearly 30,000 miles of arteries throughout the body.
That said, we have historically had limited tools to directly evaluate the dynamic nature of plaque in the coronary arteries (the arteries around the heart) themselves. Coronary Artery Calcium Scores (CACS) have been helpful, but they can detect only calcified (healed) plaque. They are unable to visualize soft or mixed (heterogenous) plaques, which are potentially the most dangerous.
Our goal with treatment is to stabilize plaque — and over time, encourage it to become more calcified and less likely to rupture. This is precisely why repeating calcium scans is usually not useful in clinical practice. Calcium scores generally rise as plaque stabilizes, even when risk is improving, making them a poor tool for monitoring treatment response over time.
This gap is where CT coronary angiography (CTCA) with advanced AI-based analysis, such as Cleerly, becomes valuable.
What is a Cleerly scan?
Cleerly is an FDA-cleared artificial intelligence (AI) platform that analyzes CT coronary angiograms in far greater detail than traditional visual interpretation alone. We have been using this technology in our practice for approximately two years, as an adjunct to our standard CIMT in select patients. It allows for precise, standardized measurement of plaque volume, plaque type (soft, mixed or calcified), and the degree of narrowing in each coronary artery.
Why is this helpful?
Cleerly transforms a CT scan into a quantitative assessment of coronary artery disease. Rather than a simple (binary) score on a coronary calcium scan, we gain a detailed map of plaque burden and composition. This helps us better stratify risk, personalize treatment intensity and assess whether therapies are achieving the goal of plaque stabilization.
What does it reveal?
Cleerly can identify non-calcified and mixed (heterogenous) plaque that would be invisible on a calcium scan — a scenario we see frequently in younger individuals. It also helps distinguish stable plaque from higher-risk plaque features, offering insight into disease activity — not just disease presence.
Risks, cost, and logistics
This mode of testing is considered non-invasive, in that we obtain a great deal of information without the procedural risk of a traditional coronary angiogram (heart catheterization). The radiation exposure from a modern CT coronary angiogram is modest — generally lower than that of a nuclear stress test — and far below older CT technologies. The test does require IV contrast.
Costs vary by region; there is typically a “hard cost” for the Cleerly analysis itself, as this is not generally covered by insurance. Insurance may cover the CT coronary angiogram in certain clinical scenarios, but coverage is variable and based on individual insurance companies. The test is not performed annually; for most patients, it is done once or repeated only after several years if clinically indicated.
Bottom line
CT coronary angiography with Cleerly analysis is not essential for everyone, but it is available and highly informative in specific scenarios. We use it selectively to better understand the health of the arteries around the heart and to ensure that our prevention and treatment strategies are successfully halting and healing the disease process.