Abstract In this study we propose and evaluate AtheroRisk, a standalone integrated computer software system for the analysis of carotid B-mode ultrasound (U/S) images and videos. Our goal was to provide a tool to help physicians stratify stroke risk. The presented system is based on outcomes from different research studies, as well as European guidelines for the evaluation and treatment of carotid artery disease. The goal is to enable reproducible analysis of atherosclerotic plaques in real time. AtheroRisk brings together analysis of U/S image and/or video of the carotid arteries facilitating anonymization, standardization, noise filtering and segmentation of plaques; followed by image and motion feature extraction to derive plaque-composition and stability. All the above steps are combined to determine the annual stroke risk rate and the 5-year stroke-free survival rate. The system is powered by an SQLite local database, in which the end user can save and manage data extracted from processing and analysis in an anonymized way. The first version of AtheroRisk was developed following an incremental software development process. The developed system was verified using 54 U/S videos (27 Asymptomatic, AS; 27 Symptomatic, SY cases) while the clinician’s satisfaction and comments were collected through a questionnaire-based validation process. The results show that the integrated system proposed in this study can be successfully used for the automated image and video analysis of the CCA plaque in ultrasound videos.