Objective To investigate the value of combined 2D and 3D ultrasound,contrast-enhanced ultrasonography(CEUS)and shear-wave elastography(SWE)for the detection of carotid plaques,and to analyze their value in predic-ting recurrence of ischaemic stroke(IS).Methods A total of 95 patients with first-ever IS and carotid atherosclerotic plaque from October,2021 to January,2023 in the Second Affiliated Hospital of Xinjiang Medical University were select-ed,and divided into a recurrence group and a non-recurrence group according to whether they had recurred or not.Risk factors for relapse in patients with IS were analyzed using logistic regression.Receiver operating characteristic(ROC)curves were used to analyze the value of different ultrasound techniques in predicting the recurrence of IS.Results Five cases were lost to follow-up.The recurrence rate was 41.11%,and there were no deaths after treatment.The proportion of hypertension in the recurrent group was higher than that in the non-recurrent group,and the proportion of good medica-tion compliance was lower than that in the non-recurrent group(P<0.05).The ratio of CEUS blood flow grade Ⅲ to Ⅳ,2-D intima-media thickness(IMT)and 3-D-TPA in the recurrent group were higher than those in the non-recurrent,while the mean Young's modulus was lower than that in the non-recurrent group(P<0.05).Multivariate logistic regres-sion analysis showed that CEUS blood flow level Ⅲ to Ⅳ,high 2-IMT,large 3-3D total carotid plaque area(TPA)and low mean Young's modulus were risk factors for recurrence in IS patients,and good medication compliance was a protec-tive factor(P<0.05).ROC curve analysis showed that the AUC of 2-D IMT,3-D TPA,mean Young's modulus and CEUS blood flow Ⅲ to Ⅳ in predicting recurrence of in IS patients were 0.674,0.717,0.729 and 0.746,respectively.The combined predictive AUC of 0.908 was higher than that of single detection(P<0.05).Conclusion 2D,3D and SWE and CEUS ultrasound techniques have some clinical value in predicting the recurrence of IS by evaluating carotid plaque instability,and the combined value of the four is higher.