Renewed interest in the neovascularity of atherosclerotic plaques has followed the work of Imparato et al., which confirmed the importance of carotid intraplaque hemorrhage in the production of symptomatic extracranial vascular disease. We have studied the detailed histology of 91 carotid atheromatous plaques with particular regard to hemorrhage and neovascularity and have confirmed the findings of earlier investigators while observing degenerative changes (not previously reported) in these new vessels. The possible role of systemic hypertension in intraplaque hemorrhage and the acceleration of the atherosclerotic process is discussed.