myocardial infarction, revascularization, or death because of cardiovascular reasons). Methods-In total, 349 at-risk subjects provided written informed consent to carotid 3-dimensional ultrasound and were analyzed for ulcerations. Ulcer volume was defined as a distinct discontinuity in an atherosclerotic plaque, with a volume ≥1.00 mm 3 as measured using manual segmentation. The sum of the volumes of all ulcers seen in both carotids was the total ulcer volume. Participants were monitored for ≤5 years for outcomes, including cardiovascular events and death. Results-Kaplan-Meier survival analysis showed that subjects with total ulcer volume ≥5 mm 3 experienced a significantly higher risk of developing stroke, transient ischemic attack, or death (P=0.009) and of developing stroke/transient ischemic attack/death/myocardial infarction/revascularization (P=0.017). Lower ulcer volumes did not predict events nor did ulcer depth. Conclusions-Volume of carotid ulceration on 3-dimensional ultrasound predicts cardiovascular events. In addition to improving risk stratification, ulceration is a potential therapeutic target.

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