Ultrasound imaging is a safe, non-invasive first level examination used to describe features of carotid atherosclerotic plaques of the carotid arteries. Sonographic plaque characteristics are considered to be predictive of subsequent cerebral ischemic events. 

Carotid ultrasound allows to determine several traits of carotid plaques namely echogenicity, characteristics of the surface and more generally morphology. All these features provide clues to differentiate a so defined “vulnerable” from a “non-vulnerable” carotid plaque, thus helping in patients risk stratification and management. Indeed, vulnerable carotid plaques are more prone to cause cerebral embolic events regardless of degree of stenosis and a high proportion of resulting strokes are likely due to rupture or erosion of unstable plaques irrespective of the degree of stenosis.