The intestinal microbiota participates in maintaining the homeostasis of the intestinal environment, and the imbalance caused by changes in its composition or distribution and activity is called intestinal microbiota imbalance. Carotid atherosclerosis, especially vulnerable carotid plaques, will increase the risk of ischemic stroke. Researches have shown that intestinal microbiota can participate in the occurrence and development of carotid artery plaques through its metabolites as signaling molecules, and targeted drugs that improve intestinal microbiota imbalance are expected to become a new treatment modality for vulnerable carotid artery plaques.