{
  "abstract": "Conventional cardiovascular risk scores estimate the probability of future events; however, these risk scores do not directly quantify the presence or extent of subclinical atherosclerosis. This narrative review critically evaluates the current evidence on the carotid plaque score (CPS), a semiquantitative ultrasound-based measure of carotid atherosclerotic burden across predefined arterial segments. Population-based cohorts have consistently shown that carotid plaque presence and burden are independently associated with cardiovascular and cerebrovascular events. Studies specifically evaluating CPS have further suggested an incremental prognostic value beyond conventional risk models, particularly for ischemic stroke and major adverse cardiovascular event (MACE). However, CPS does not represent a single standardized metric. Therefore, proposed thresholds, including CPS ≥2 and CPS >3, were derived using different plaque definitions, arterial segments, scoring methods, and study populations and are not directly interchangeable. Meanwhile, CPS is more accessible, non-ionizing, and relatively inexpensive compared with coronary artery calcium (CAC), but it is less extensively validated and less standardized. Nonetheless, available comparative evidence indicates that CAC provides superior discrimination for coronary outcomes. In contrast, carotid plaque assessment may offer complementary information for cerebrovascular risk and in selected individuals with discordant estimated risk or no detectable coronary calcification. No randomized trial has demonstrated that treatment decisions guided by CPS improve clinical outcomes. Accordingly, current guidelines generally position carotid plaque imaging as a selective risk modifier rather than a routine screening or stand-alone treatment-allocation tool. Thus, broader clinical implementation will require standardized acquisition and reporting protocols, external validation across diverse populations, integration with established risk models, and prospective studies evaluating whether CPS-guided preventive strategies improve patient outcomes.",
  "abstract_shown": true,
  "affiliations": [
    "ACTION Study Group, Inserm UMRS1166, Heart Institute, Pitié-Salpêtrière Hospital, Sorbonne University, 75013 Paris, France",
    "Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL 32611, USA",
    "UOC UTIC Emodinamica e Cardiologia, Santa Maria Goretti Hospital, 04100 Latina, Italy",
    "Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy",
    "National Institute of Cardiology, Cardiovascular Surgery and Interventional Cardiology (INCCI), 1210 Luxembourg City, Luxembourg",
    "Cardiac Rehabilitation Unit, Rehabilitation Clinic ‘Villa delle Magnolie’, 81020 Castel Morrone, Caserta, Italy",
    "IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy",
    "Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy",
    "Faculty of Medicine, Alexandria University, 5372066 Alexandria, Egypt",
    "Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy",
    "Department of Clinical and Experimental Medicine, University of Messina and Azienda Ospedaliera Papardo, 98124 Messina, Italy",
    "Center for Prevention of Cardiovascular Disease, Department of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA",
    "Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Eisenberg R&D authority and Faculty of Medicine, Hebrew University of Jerusalem, 9103102 Jerusalem, Israel"
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 15,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "David Sulman",
      "orcid": "0000-0002-9400-1324"
    },
    {
      "affs": [
        1
      ],
      "name": "Stefano Cacciatore",
      "orcid": "0000-0001-7504-3775"
    },
    {
      "affs": [
        2
      ],
      "name": "Marco Bernardi",
      "orcid": "0000-0001-9269-8829"
    },
    {
      "affs": [
        2,
        3
      ],
      "name": "Luigi Spadafora",
      "orcid": "0000-0001-6443-4121"
    },
    {
      "affs": [
        4
      ],
      "name": "Atul Pathak",
      "orcid": "0000-0001-6151-0096"
    },
    {
      "affs": [
        5
      ],
      "name": "Francesco Perone",
      "orcid": "0000-0002-1418-7908"
    },
    {
      "affs": [
        6,
        7
      ],
      "name": "Stefano Figliozzi",
      "orcid": "0000-0003-2991-1548"
    },
    {
      "affs": [
        8
      ],
      "name": "Ali Abdelaziz",
      "orcid": "0009-0007-1940-4258"
    },
    {
      "affs": [
        9
      ],
      "name": "Felice Gragnano"
    },
    {
      "affs": [
        9
      ],
      "name": "Paolo Calabro"
    },
    {
      "affs": [
        3
      ],
      "name": "Dario Mafrica",
      "orcid": "0009-0002-8991-1697"
    },
    {
      "affs": [
        10
      ],
      "name": "Giuseppe Andò",
      "orcid": "0000-0001-5552-6382"
    },
    {
      "affs": [
        11
      ],
      "name": "Michael D. Shapiro",
      "orcid": "0000-0002-9071-3287"
    },
    {
      "affs": [
        12
      ],
      "name": "Elad Asher",
      "orcid": "0000-0003-3381-605X"
    },
    {
      "affs": [
        0
      ],
      "name": "Pierre Sabouret",
      "orcid": "0000-0002-0243-3673"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4k7fybk9tcyrt.bib",
  "cited_by": 0,
  "doi": "10.31083/rcm50123",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13732675/",
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  "landing_url": "https://doi.org/10.31083/rcm50123",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Review"
    ],
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      "openalex",
      "2705|Cerebrovascular and Carotid Artery Diseases"
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  "pdf_url": "https://storage.imrpress.com/IMR/2113453944386592800/application/2153-8174-27-10-50123.pdf",
  "pmcid": "PMC13732675",
  "pmid": "42985038",
  "published": "2026-10-23",
  "publisher": "IMR Press",
  "ris": "https://research.draconitic.com/paper/4k7fybk9tcyrt.ris",
  "sources": [
    {
      "first_seen": "2026-11-08T12:22:37Z",
      "native_id": "PMC13732675",
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      "url": "https://doi.org/10.31083/rcm50123"
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  "subjects": [
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      "field": "medicine",
      "origin": "openalex:2705|Cerebrovascular and Carotid Artery Diseases",
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  "title": "Carotid Plaque Score: A Useful Tool or Futile Gadget for Risk Assessment? An Update",
  "title_text": "Carotid Plaque Score: A Useful Tool or Futile Gadget for Risk Assessment? An Update",
  "type": "peer-reviewed",
  "updated_at": "2026-11-08T12:22:37Z",
  "url": "https://research.draconitic.com/paper/4k7fybk9tcyrt",
  "venue": "Reviews in Cardiovascular Medicine",
  "versions": []
}