Objective To explore the value of intravascular ultrasound virtual histology (VH-IVUS) and real-time shear elastography (SWE) in evaluating the stability of carotid plaque and cerebral infarction. Methods From December 2018 to December 2020, 130 patients with carotid atherosclerotic plaques (201 plaques) in 960th Hospital of the joint logistics support force of the Chinese people's Liberation Army were selected, including 53 patients with recent cerebral infarction and 77 patients without cerebral infarction, the differences of VH-IVUS score and average young's modulus of plaque with different properties were analyzed, the value of VH-IVUS score and average young's modulus in predicting cerebral infarction was analyzed. Results Among 201 plaques, 45 were soft plaques, 98 were mixed plaques, and 58 were calcified plaques. The VH-IVUS score of unstable plaques was significantly higher than that of stable plaques (P＜0.05), while the mean Young's modulus was significantly lower than that of stable plaques (P＜0.05). The area under the ROC curve of stable plaques evaluated by VH-IVUS score and mean Young's modulus were 0. 789 and 0.875, respectively, P＜0.05. The triglyceride (TG) and low density lipoprotein cholesterol (LDL-C) in the infarction group were significantly higher than those in the non-infarction group (P＜0.05), while the high density lipoprotein cholesterol (HDL-C) was significantly lower than that in the cerebral infarction group (P＜0.05). The plaque VH-IVUS score of cerebral infarction group was significantly higher than that of non-cerebral infarction group (P＜0.05), while the mean Young's modulus was significantly lower than that of non-cerebral infarction group (P＜0.05);The area under the ROC curve of cerebral infarction evaluated by VH-IVUS score and mean Young's modulus were 0.658 and 0.822, respectively, P＜0.05. Conclusion VH-IVUS and SWE have good value in evaluating the stability of carotid artery plaques and evaluating cerebral infarction, among them, SWE has high evaluation value.