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Background: Vasa vasorum neovascularization (VVN) is one of the characteristics of vulnerable plaque. The purpose of this study was to assess VVN using optical frequency domain imaging (OFDI) between symptomatic and asymptomatic carotid artery plaques, and to know its association with progression of stenosis.Methods: The carotid artery plaques were examined before angioplasty using OFDI system (LUNAWAVETM, Terumo). VVN was defined as a no-signal tubuloluminal structures recognized on at least 3 consecutive images. A total number of VVN was compared between symptomatic and asymptomatic plaques. The stenosis was evaluated by carotid duplex scan within one year. The lesion was diagnosed as ‘progressive’ when the stenotic degree and peak systolic velocity were increased.Results: A total of 60 patients (29 symptomatic, 11 progression) were included. VVN was detected in 54 patients (90%), the total number of VVN was significantly higher in progressive stenosis (8.9 ± 5.7 vs. 4.5 ± 3.8, p = 0.02). However, there was no relationship between the number of VVN and ischemic symptom.Conclusions: VVN was more frequently observed in progressive stenosis. Evaluation of VVN using OFDI might be useful to predict progression of carotid artery stenosis.