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Background and Purpose: To prevent ischemic strokes caused by carotid artery stenosis, carotid artery stenting (CAS) and carotid endarterectomy (CEA) have been utilized. However, complications could be linked to either or both procedures. The purpose of our study is to find the most efficient carotid ultrasound method to forecast periprocedural risk (embolization, new neurological symptoms)., Methods: We used Pubmed, EMBASE, and the Cochrane Library to conduct a systematic literature search for the years 2000 to 2022., Results: Thegrayscale medium (GSM) scale of plaque is the most promising criterion for evaluating periprocedural complications. According to the published observations (relatively small cohorts), peri-procedural problems would be significantly predicted by ≤ 20 of grayscale medium cut-off values. The diffusion-weighted MRI (DW-MRI) is the most sensitive method for assessing whether stenting or carotid endarterectomy resulted in peri-procedural ischemiclesions on diffusion-weighted MRI., Conclusion: A future, large-scale, multi-centerstudy should confirm which grayscale medium value is optimal to forecast periprocedural ischemic complications.