Abstract: Objective To examine the characteristics of carotid arteriosclerotic plaques in contrast-enhanced ultrasonography (CEUS) of neovascularization. Methods Seventy-eight patients with carotid atherosclerotic plaques were examined with real-time CEUS. The perfusion modes of neovascularization in relation to the carotid arteriosclerotic plaques were identified. Patients were categorized into four groups according to their plaque echo. Five patients with serious atherosclerotic carotid artery disease received carotid endarterectomy. The intra-plaque neovascularization recorded by CEUS were validated by post-surgery pathology examinations of the tissues. Results In routing ultrasound examinations, 23 (29.49％) plaques were identified with low-echo, 30 (38.46％) with mixed-echo, 20 (25.64％) with equal-echo, and 5 (6.41％) with high-echo. The CEUS imaging revealed 60 carotid atherosclerotic plaques (76.9%）with various degrees of enhancement in intra-plaque neovascularization. The thickness of plaques was correlated with the enhanced intensity of ultrasonography, with a Pearson correlation coefficient of 0.686 (P<0.05). Compared with equal and high echo plaques, the enhanced intensity of ultrasonography in low and mixed echo plaques was higher (P<0.05). The intra-plaque neovascularization recorded by CEUS was correlated with the grade of neovascularization resulted from post-surgery examinations (Spearman coefficient=0.886, P<0.05). Conclusion The real-time CEUS can assess the neovascularization in carotid atherosclerotic plaques non-invasively and quantitatively.