Cardiovascular events such as myocardial infarction or stroke resulting from atherosclerosis still account for the majority of deaths worldwide. New imaging approaches focusing on the visualization of inflammation in the vessel wall may emerge as tools for individualized risk assessment and prevention of events. Enzymes such as matrix-metalloproteinases (MMPs) are involved in several steps in plaque progression driving plaques into vulnerable, rupture-prone states. Targeting of MMPs for imaging is therefore a promising strategy. The rationale, potential, and current status of imaging MMPs in the clinical context of stroke and myocardial infarction are reviewed here from a clinical viewpoint.