Huo R, Xu H, Yang D, et al. - Via this prospective study, researchers examined how carotid plaque characteristics are associated with perioperative cerebral blood flow (CBF) utilizing MRI. They analyzed 3T, black‐blood T1‐ and T2‐weighted, 3D time‐of‐flight, and simultaneous noncontrast angiography intraplaque hemorrhage for this research in 131 patients with carotid moderate‐to‐severe stenosis referred for carotid endarterectomy (CEA). They performed measurement of the relative CBF (rCBF = CBF_{index‐hemisphere}/CBF_{contralateral‐hemisphere}) and the CBF difference ratio (DR_CBF = [CBF_post‐CEA – CBF_pre‐CEA]/CBF_pre‐CEA) in the middle cerebral artery territory. Positive associations were observed of NWI with rCBFpost-CEA and DRCBF. Furthermore, the presence of carotid LRNC was noted to be positively linked with rCBF pre-CEA, however, there was a negative correlation of NWI with DRCBF. Higher likelihood to achieve higher rCBF and greater improvement of CBF after CEA surgery were noted for patients with larger carotid plaque burden. Data, in addition, suggest the possibility of increased pre-CEA rCBF and less improvement of CBF after CEA among patients with carotid LRNC, which might provide direct imaging evidence that patients with larger carotid plaque burden and a simple component would benefit more from CEA, particularly the improvement of CBF. Overall findings suggest that CBF change following CEA might be effectively determined assessing carotid plaque burden and components, particularly lipid‐rich necrotic core.