Aim To investigate the treatment efficacy of Tongxinluo compared with statins in patients with carotid atherosclerotic plaques. Methods We systematicly and exhaustively retrieved the Chinese and foreign language databases from their establishment date to May 1, 2015 to collect the randomized, controlled and clinical trials about the treatment efficacy of Tongxinluo compared with statins in patients with carotid atherosclerotic plaques, and then the RevMan 5.2 soft ware was used for Meta analysis. Results A total of 23 randomized controlled trials were included, involving 2355 patients with mean duration of 20±7 weeks. The results of Meta analysis showed the single use of Tongxinluo and statins in improving carotid artery intima-media thickness (IMT) and blood lipid levels had no significant difference (MD was -0.06, 95%CI was -0.17~0.05, P＝0.26 and MD was 0.19, 95%CI was -0.00~0.38, P＝0.05). But the single use of Tongxinluo had more advantages than statins in improving triglyceride (triglyceride,TG) level (MD was -0.28, 95%CI was -0.44~-0.11, P＝0.001). Tongxinluo combined with statins had more advantages than single using statins in the improvement of patients with IMT, plaque area, plaque score, blood lipid level and C-reactive protein (CRP) (P＜0.01). However, as to evaluate the adverse reactions, Tongxinluo had less percentage than statins (OR was 0.44, 95%CI was 0.27~0.73, P＝0.001). Conclusion In the treatment of patients with carotid atherosclerotic plaques, Tongxinluo combined with statins is the best therapeutic scheme in our study.