Abstract: Objective To investigate the differences of carotid atherosclerotic (AS) plaques between symptomatic and asymptomatic sides in cerebral ischemic patients detected using 3.0T high-resolution MR imaging. Methods One hundred and two patients with infarction or transient ischemic attack (TIA) in our hospital from June 2012 to June 2013 were recruited in our study. Each patient was received high-resolution MR examination of bilateral carotid arteries in two weeks. The differences of carotid atherosclerotic plaques between symptomatic and asymptomatic sides were investigated. Results Of the 102 cerebral ischemic patients, 52 had infarction and 50 developed TIA. Compared with the carotid atherosclerotic plaques between symptomatic and asymptomatic sides, the luminal stenosis showed no difference (P> 0.05) while the maximum wall thickness and lesion length had signifcant statistic differences (P=0.000). The occurrence rates of vulnerable compositions such as hemorrhage, lipid-rich core and fbrous cap rupture in symptomatic sides were obviously higher than those in asymptomatic sides and showed signifcant statistic difference (Z=-6.525, P=0.000). Conclusion The severity and vulnerability of carotid atherosclerotic plaque in symptomatic side are obviously higher than the asymptomatic side. The occurrence rates of vulnerable compositions in symptomatic sides are higher.