Ultrasound is of great significance in the evaluation of carotid atherosclerotic plaque. It plays an important role in the standard management of carotid plaque. In the present article, plaque surface morphology, plaque echo, plaque neovascularization and plaque inflammation were discussed in clinical practice. The existing problems in these aspects were summarized and possible solutions were suggested . Ultrasound has unique advantages in carotid plaque evaluation. Standard examination and evaluation with uniform terminology are very important for plaque management. Therefore, process-based and standardized ultrasound assessment is a hot topic in clinical practice.