Objective: To investigate the value of multimodal ultrasound technology in assessing the characteristics of carotid vulnerable plaques and analyze its correlation with the onset of ischemic stroke. Methods: A total of 93 patients were selected as study subjects, including 70 in the stroke group and 23 in the control group (without a history of stroke). All participants underwent conventional ultrasound, contrast-enhanced ultrasound (CEUS), and shear wave elastography (SWE) examinations. The differences in morphological features, enhanced intensity (EI), area under the curve (AUC), and Young's modulus values of plaques between the two groups were compared. Logistic regression analysis was used to identify independent risk factors for stroke onset. Results: The maximum plaque thickness was greater in the stroke group, with a higher proportion of hypoechoic, irregularly shaped plaques and plaques with fibrous cap defects (P<0.05). CEUS showed that the EI and AUC of plaques in the stroke group were higher than those in the control group (P<0.05). SWE measurements revealed that the Young's modulus values of plaques in the stroke group were lower than those in the control group (P<0.05). Multivariate Logistic regression analysis indicated that EI (OR=1.432, 95%CI: 1.152~1.781) and SWE Young's modulus value (OR=0.921, 95%CI: 0.883~0.961) were independent influencing factors for stroke onset. Conclusion: The combined application of multimodal ultrasound provides a comprehensive assessment of carotid plaque vulnerability. Rich intraplaque neovascularization (increased EI) and soft plaque texture (decreased SWE Young's modulus value) are independent influencing factors of stroke onset. Prospective studies should be conducted in the future to further explore the causal relationship.