The rupture of carotid atherosclerotic plaques and thrombosis are the main risk factor for ischemic stroke. The risk of carotid plaque rupture is closely related with the local biomechanical situation, morphology, components and biological activity of the carotid plaques. In this article, the research progress on methodology for studying carotid stenosis biomechanics, the risk of vulnerable plaque rupture in carotid stenosis and decision-making in clinical treatment, the animal modeling and experiment on vulnerable carotid plaques, and the components and biological activities of carotid plaques was summarized, the existing problems were analyzed, and the in-depth prospective about the biomechanical mechanism and quantitative assessment indices for vulnerable carotid plaques was also proposed, expecting to provide necessary theoretical guidance for feasible decision-making on the treatment of carotid stenosis.