Luca Saba, Azienda Ospedaliero Universitaria di Cagliari
Pier Luigi Antignani, Vascular Center
Ajay Gupta, Weill Cornell Medicine
Riccardo Cau, Azienda Ospedaliero Universitaria di Cagliari
Kosmas I. Paraskevas, Central Clinic of Athens
Pavel Poredos, Univerzitetni Klinični Center Ljubljana
Bruce Wasserman, The Johns Hopkins Hospital
Hooman Kamel, Weill Cornell Medicine Feil Family Brain & Mind Research Institute
Efthymios D. Avgerinos, University of Pittsburgh Medical Center
Rodrigo Salgado, Universitair Ziekenhuis Antwerpen
Federico Caobelli, University Hospital Bern
Leonardo Aluigi, Private Villalba Hospital (GVM)
Luis Savastano, Mayo Clinic
Martin Brown, University College London Hospitals NHS Foundation Trust
Tom Hatsukami, University of Washington
Emad Hussein, Ain Shams University
Jasjit S. Suri, AtheroPoint™
Armado Mansilha, Faculdade de Medicina da Universidade do Porto (FMUP)
Max Wintermark, Stanford University School of Medicine
Daniel Staub, Universitätsspital Basel
Jose Fernandes Montequin, National Institute of Angiology and Vascular Surgery
Ruben Tomas Toro Rodriguez, National Institute of Angiology and Vascular Surgery
Niranjan Balu, University of Washington
Jan Pitha, Institutu Klinické a Experimentální Medicíny
M. Eline Kooi, CARIM School for Cardiovascular Disease
Brajesh K. Lal, University of Maryland, Baltimore (UMB)
J. David Spence, Robarts Research InstituteFollow
Giuseppe Lanzino, Institutu Klinické a Experimentální Medicíny
Hugh Stephen Marcus, Department of Clinical Neurosciences
Marcello Mancini, Consiglio Nazionale delle Ricerche

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Cardiovascular disease (CVD) is the leading cause of mortality and disability in developed countries. According to WHO, an estimated 17.9 million people died from CVDs in 2019, representing 32% of all global deaths. Of these deaths, 85% were due to major adverse cardiac and cerebral events. Early detection and care for individuals at high risk could save lives, alleviate suffering, and diminish economic burden associated with these diseases. Carotid artery disease is not only a well-established risk factor for ischemic stroke, contributing to 10%–20% of strokes or transient ischemic attacks (TIAs), but it is also a surrogate marker of generalized atherosclerosis and a predictor of cardiovascular events. In addition to diligent history, physical examination, and laboratory detection of metabolic abnormalities leading to vascular changes, imaging of carotid arteries adds very important information in assessing stroke and overall cardiovascular risk. Spanning from carotid intima-media thickness (IMT) measurements in arteriopathy to plaque burden, morphology and biology in more advanced disease, imaging of carotid arteries could help not only in stroke prevention but also in ameliorating cardiovascular events in other territories (e.g. in the coronary arteries). While ultrasound is the most widely available and affordable imaging methods, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), their combination and other more sophisticated methods have introduced novel concepts in detection of carotid plaque characteristics and risk assessment of stroke and other cardiovascular events. However, in addition to robust progress in usage of these methods, all of them have limitations which should be taken into account. The main purpose of this consensus document is to discuss pros but also cons in clinical, epidemiological and research use of all these techniques.