Objective To investigate the value of transcranial Doppler （TCD） microembolus monitoring in evaluating the efficacy of PAS （anti-oxidation， anti-platelet， and lipid-regulating） therapy in the treatment of vulnerable carotid plaques.Methods A total of 46 patients with vulnerable carotid plaques who received PAS therapy in The 910th Hospital of Chinese People's Liberation Army from July 2019 to July 2021 were enrolled as the research group， and 38 patients with vulnerable carotid plaques who were treated with AS （anti-platelet and lipid-regulating） therapy alone from June 2015 to June 2019 were enrolled as the control group. TCD microembolus monitoring was performed for both groups before and after treatment， and plaque stability was assessed.Results After treatment， 1 patient in the research group and 6 in the control group were found to have positive microembolic signals （P<0.05）. After treatment， the research group had a significantly lower carotid intima-media thickness （IMT） than the control group （P<0.05）. The research group had a significant reduction in IMT after treatment （P<0.05）， while the control group showed no significant change after treatment （P>0.05）. Both groups were followed up for 1 year， and compared with the control group， the research group had a significantly lower incidence rate of ischemic events and a significantly lower severity of stroke in patients with acute cerebral infarction （P<0.05）. There were three patients with adverse gastrointestinal reactions， which did not affect treatment and prognosis.Conclusions PAS treatment of vulnerable carotid plaques can help to improve plaque stability， reduce the risk of stroke， and alleviate the severity of stroke.