Objective: The aim of the study is to establish a fluid-structure interactive model of carotid atherosclerotic plaque to study the biomechanical effects under cervical rotatory manipulation. It could be used to evaluate the rupture risk of carotid atherosclerotic plaque under cervical rotatory manipulation. Methods: The fluid-structure interactive model was used to simulate the tensile deformation of the plaque and lumen under the cervical rotatory manipulation by 7%±9%.The maximum flow shear force (FMSS), maximum wall shear stress (WSS), maximum plaque wall stress (PWS), wall tensile stress (Von mises stress, VWTS) and wall pressure were recorded. Results: The Max_WSS value of plaque was 40.54 Pa under 16% carotid stretch deformation.Max_PWS value was 66.16kPa, far less than the threshold of plaque rupture.The fiber cap’s Max_VWTS and the maximum strain (156.75kPa /0.56) were larger than the fracture stress/strain range. The lumen Max_VTWS (1040.30 kPa) has approached the threshold of rupture of the medial membrane, which may cause vascular injury. Conclusion: Large carotid artery stretching when the cervical spine rotates to the end range of motion may cause damage to the epidermal tissue of the plaque, leading to abscission. Lesions, ulcers, bleeding and vascular damage may form inside the plaque, which would affect the stability of the plaque. Cervical rotatory manipulation should be performed cautiously in patients with cervical disease with carotid atherosclerotic plaque, the FSI assessment of plaques before manipulation may be an effective safety screening method.