Carotid atherosclerotic stenosis is a main cause for ischemic stroke. Evaluation of plaque characteristics is a crucial step for intervention method selection from the comprehensive scheme of treatment of carotid stenosis. At present, no objective diagnostic standards for plaque vulnerability have been finalized, and the pathological diagnosis remains the most reliable assessment approach. A great number of studies on the plaque vulnerability evaluation have been made by investigators in China and abroad during recent years, and the achievements from them may positively influence choice of treatment plan for carotid stenosis.