BACKGROUND: The vasa vasorum is a network of small blood vessels that supply large blood vessel. Histological data associate proliferation of adventitial vasa vasorum and intraplaque neovascularization with vulnerable plaques represented by symptomatic cardiovascular disease (CVD) and events (CVE). In this observational study, we evaluated that clinical characteristics of carotid intraplaque neovascularization and correlation with the presence and occurrence of CVD. METHODS: The contrast-enhanced carotid ultrasound examinations of 82 subjects (mean age 69짹9 years, 80% male) were analyzed for the presence of intraluminal plaque, plaque neovascularization (Grade 1=absent; Grade 2=present). These observations were correlated with preexisting cardiovascular risk factors, presence of CVD, and history of CVE (myocardial infarction and transient ischemic attack/stroke). RESULTS: Among 125 intraluminal carotid plaques, intraplaque neovascularization was found in 61 plaques and intraplaque enhancement with documented microsphere activity was noted in 57 plaques (46%). The presence of intraluminal carotid plaque was directly correlated to cardiovascular risk factors, CVD, and CVE (P<0.05). The presence of intraplaque neovascularization was associated with significant more subjects with coronary artery diasease than absence of intraplaque neovascularization (p = 0.016). Subjects with intraplaque neovascularization Grade 2 had significantly more often a history of CVE than subjects with intraplaque neovascularization Grade 1 (P=0.031). Multivariate logistic regression analysis revealed that presence of plaque was significantly associated with CVD (odds ratio 3.2) and intraplaque neovascularization grade 2 with CVE (odds ratio 2.5). CONCLUSIONS: The presence and degree of plaque neovascularization were associated with CVD and CVE.