Ischemic stroke (IS), also known as cerebral infarction, is the necrosis of brain tissue caused by local ischemia and hypoxia. It is one of the most threatening cerebraovascular diseases today, with significant disability and mortality. The most common cause is atherosclerotic lesions, and the carotid artery is one of the most frequently affected vessels. Carotid atherosclerotic plaque is an important cause of carotid artery stenosis or even occlusion. The plaque's lipid core necrosis, fibrous cap thinning, neovascularization, and significant inflammatory response will increase the vulnerability of the plaque. In situ thrombus formed on the surface of vulnerable plaque after rupture and distal thrombus caused by partial thrombus shedding can both cause atherosclerotic cerebral infarction. Therefore, early detection and active treatment of vulnerable plaque is of great significance for improving the prognosis of IS. This review summarizes previous experimental studies and reviews the evaluation methods and clinical intervention of vulnerable plaques.