Atherosclerosis of the internal carotid artery is an important cause of disabling ischemic stroke and therefore constitutes a major medical, social, and economic issue. Although advances in vascular imaging modalities during the last decades allow to risk stratify patients not solely on the degree of carotid artery stenosis but also based on ‘high risk’ features, there still remains a controversy over patient selection for carotid artery revascularization. Among other features of plaque vulnerability, there is an increasing body of evidence that inflammation is a key factor in the initiation, progression and destabilization of atherosclerotic plaques. Microwave radiometry (MWR) is a new imaging method that is based on the ability to detect noninvasively, with high accuracy, the relative changes of temperature in human tissues reflecting inflammatory activation. This review article aims to: (1) give an overview of current clinical experience with MWR in carotid arteries and (2) present its potential role for risk stratification.