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B-mode and Doppler ultrasound are commonly used for the evaluation of atherosclerosis in the carotid arteries. Recently, contrast-enhanced ultrasound (CEUS) has been introduced as a technique to improve the detection of carotid atherosclerosis and evaluate the presence of intraplaque neovascularization, which is considered a marker of plaque vulnerability. The present review focuses on the role of CEUS for the assessment of atherosclerosis and plaque instability. Currently available literature and future developments with CEUS are discussed.