Abstract: Vulnerable carotid plaques are key risk factors for ischemic stroke, and accurate assessment of their stability holds great clinical significance for stroke prevention. Contrast-enhanced ultrasound (CEUS), with its high spatial resolution and real-time dynamic imaging capability, can clearly visualize the intraplaque microvasculature, providing important imaging evidence for evaluating plaque vulnerability. Currently, CEUS has made significant progress in assessing intraplaque angiogenesis, characterizing plaque composition, and predicting the risk of plaque rupture. This article systematically reviews the latest research advances on CEUS in the assessment of carotid plaque vulnerability, focusing on its clinical value in diagnosis and risk stratification, and discusses future research directions—aiming to inform clinical monitoring, risk-guided intervention, and personalized treatment planning for carotid atherosclerosis.