Rupture of a vulnerable atherosclerotic plaque can lead to thrombus formation and, subsequently, to ischemic events. Intraplaque microvessels are thought to play an important role in atherogenesis, since they may facilitate entrance of red blood cells and inflammatory cells into the plaque tissue due to increased endothelial permeability. Symptomatic patients underwent DCE-MRI to assess plaque microvasculature. A significantly lower vessel wall Ktrans was found in the symptomatic carotid plaque compared to the contralateral asymptomatic side. The decrease in vasa vasorum in the symptomatic plaques might be due to a higher amount of necrotic tissue on this side.