Aim To investigate the effect of calcification distribution characteristics in carotid artery plaque on plaque stability. Methods A total of 49 patients undergoing carotid endarterectomy were selected. Among all patients, the echo characteristics of carotid artery plaque were observed by two-dimensional ultrasound and contrast-enhanced ultrasound (CEUS) before carotid endarterectomy, and the number, distribution, morphology of calcification and neovascularization about calcification peripheral were recorded. And all patients were divided into groups according to the location of calcification, quantity, morphology, and whether there were neovascularization adjacent to calcification, which were used to observe plaques stability as the gold standard of pathology. Results In this study, there were no significant difference between calcification location, morphology, neovascularization about calcification peripheral and plaque stability (χ²=0.415, P=0.813; χ²=2.164,P=0.339；χ²=3.352,P=0.095). However, there was a significant difference between the calcification number in plaque and plaque stability (χ²=5.555,P=0.029). Conclusions The number of calcifications has a certain effect on the stability of carotid plaques, and multiple calcification can lead to plaque instability.