To assess fly through ultrasound imaging (FTUS) in evaluation of carotid artery atherosclerosis, we prospectively performed conventional sonography and FTUS of the carotid artery on 66 patients with suspicion for atherosclerosis. Characteristics of arterial intima, atherosclerotic plague, luminal narrowing, and carotid stent graft displayed on FTUS were compared with that on conventional sonography. On FTUS, normal carotid artery wall was smooth in appearance, mild carotid atherosclerosis appeared focal arterial wall irregularity and small plague formation, arterial luminal reduction resulted from progressive artery plaques, and carotid stent had irregular inner lumen and tight fit against the arterial wall. A total of 38 plagues were detected by conventional sonography, while 48 plagues were depicted by FTUS in 25 patients. Using magnetic resonance angiography as a reference standard, 17 cases with >50% and 3 cases with <50% luminal reduction measured on FTUS. However, all those 20 cases were measured with >50% luminal reduction on conventional sonography. Compared with conventional sonography, FTUS can dynamically display intraluminal structure on real-time three-dimensional imaging morphologically to improve the accuracy in detecting atherosclerotic plague and assessing luminal narrowing in the carotid artery. (C) 2013 Published by Elsevier Inc.