To explore the different value of SMI and CEUS in the diagnosis of neovascularization in carotid atherosclerotic plaque. Methods Sixty-four patients (99 carotid atherosclerotic plaques) admitted to our hospital underwent SMI and CEUS, respectively. SMI and CEUS showed positive rate and position difference of neovascularization in carotid plaque, and two methods were diagnosed. Consistency of neovascularization within the plaque. Results 99 carotid plaques, CEUS neovascularization rate (79.80%) was significantly higher than SMI (53.54%), SMI and CEUS detection of neovascularization with moderate consistency (K = 0.464, P = 0.000). There are differences in the location distribution of new blood vessels detected by SMI and CEUS. SMI blood flow imaging is more likely to show neovascularization at the top, and CEUS is more likely to display neovascularization at the base. Conclusion SMI and CEUS have advantages in diagnosing neovascularization in plaques. CEUS has high sensitivity and is easy to display neovascularization at the base of plaque. SMI and CEUS have a moderate consistency in the diagnosis of neovascularization in the plaque, and the combination of the two can provide more accurate plaque vulnerability information.