Abstract: Objective: To investigate the semi-quantitative analysis of subtle calcification features and calcium composition within carotid artery plaques using CT angiography (CTA),and to evaluate the correlation between carotid artery plaque calcification characteristics and risk of acute ischemic stroke combined with relevant laboratory indicators. Methods: A retrospective analysis was conducted on 193 stroke patients who underwent preoperative head and neck CTA examinations,with a total of 213 internal carotid arteries.Based on the presence or absence of acute ischemic stroke symptoms,the patients were divided into an asymptomatic group (n=119) and a symptomatic group (n=74).The clinical data and CTA measurement data in the two groups were subjected to univariate analysis and multivariate logistic regression analysis to identify independent risk factors for the onset of cerebral ischemic disease. Results: Univariate analysis revealed that diabetes mellitus,incidence of hyperlipidemia,vascular remodeling ratio,and plaque calcification type were influencing factors for the presence of clinical symptoms in carotid arteries (P<0.05 to P<0.01).Logistic regression analysis showed the vascular remodeling ratio was positively correlated with ischemic symptoms (OR=3.17,95%CI:1.23-7.82,P<0.01). Conclusions: The calcification characteristics of carotid atherosclerotic plaques are closely related to the instability of plaques,which can accurately predict the risk of acute ischemic stroke with good reproducibility.