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.

Angiology Care Unit Private Villalba Hospital Bologna Italy

Clinical and Translational Neuroscience Unit Feil Family Brain and Mind Research Institute Department of Neurology Weill Cornell Medicine New York USA

Department of Angiology University Hospital Basel and University of Basel Basel Switzerland

Department of Neurology and Neurosurgery University College London Hospitals London UK

Department of Neurology and Stroke Program University of Maryland School of Medicine Baltimore MD USA

Department of Radiology and Nuclear Medicine CARIM School for Cardiovascular Diseases Maastricht University Medical Center Maastricht the Netherlands

Department of Radiology Antwerp University Hospital Edegem Belgium

Department of Radiology Azienda Ospedaliero Universitaria di Cagliari Polo di Monserrato s s 554 Monserrato Cagliari 09045 Italy

Department of Radiology Neuroradiology Section Stanford University School of Medicine Stanford CA USA

Department of Radiology Weill Cornell Medical College New York NY USA

Department of Surgery University of Washington Seattle WA USA

Department of Vascular Disease University Medical Center Ljubljana Zaloska cesta 2 1000 Ljubljana Slovenia

Department of Vascular Disease University Medical Center Ljubljana Zaloska cesta 2 1000 Ljubljana Slovenia; Faculty of Medicine University of Ljubljana Vrazov trg 2 1000 Ljubljana Slovenia

Department of Vascular Surgery Central Clinic of Athens Athens Greece

Department of Vascular Surgery University of Maryland Baltimore USA; Vascular Service Veterans Affairs Medical Center Baltimore USA

Division of Vascular Surgery University of Pittsburgh Medical Center Pittsburgh Pa USA; Clinic of Vascular and Endovascular Surgery Athens Medical Group Greece

Faculty of Medicine of University of Porto Porto Portugal

Institute of Biostructures and Bioimaging National Research Council of Italy Naples 80145 Italy

Laboratory for Atherosclerosis Research Center for Clinical and Experimental Medicine Institute for Clinical and Experimental Medicine Prague Czech Republic

Monitoring and Diagnostic Division AtheroPoint™ Roseville CA USA; Knowledge Engineering Center Global Biomedical Technologies Inc Roseville CA USA; Department of Electrical and Computer Engineering Idaho State University ID USA

National Institute of Angiology and Vascular Surgery Havana Cuba

Neurosurgery Mayo Clinic Rochester MN USA

Stroke Prevention and Atherosclerosis Research Centre Robarts Research Institute Western University 1400 Western Road London N6G 2V4 ON Canada

Stroke Research Group Department of Clinical Neurosciences University of Cambridge Cambridge UK

The Russell H Morgan Department of Radiology and Radiological Science Johns Hopkins Hospital 367 East Park Building 600 N Wolfe St Baltimore MD 21287 USA

University Clinic of Nuclear Medicine Inselspital University Hospital Bern Bern Switzerland

Vascular Center Nuova Villa Claudia Rome Italy

Vascular surgery Department Ain Shams University Cairo Egypt

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