[SICOA-GISE Consensus document on carotid atherosclerotic disease: from increased intima-media thickness to stenosis....

Carotid atherosclerotic disease represents one of the leading causes of ischemic stroke. It should be considered as a pathological continuum that includes increased intima-media thickness, development of atherosclerotic plaque and progression to clinically significant carotid stenosis. Non-invasive imaging techniques currently allow accurate characterization of carotid plaque in terms of composition, echogenicity, echostructure, presence of intraplaque hemorrhage, ulceration and vascular remodeling, all factors closely associated with plaque instability and the risk of ischemic events. At the same time, advances in medical therapy and revascularization techniques have improved clinical outcomes but have also increased the complexity of therapeutic decision-making in individual patients, requiring the integration of clinical, anatomical, hemodynamic and imaging data. Despite the availability of international guidelines, areas of uncertainty and significant heterogeneity remain in clinical practice, terminology, risk stratification criteria and indications for revascularization, particularly in asymptomatic patients or those with intermediate-grade stenosis. The aim of the present SICOA-GISE consensus document is to harmonize terminology between the different disciplines involved (cardiology, neurology, radiology and vascular surgery), promote a multidisciplinary approach and provide practical guidance on the appropriate use of imaging techniques, identification of high-risk carotid plaque and integration of medical and interventional therapy.