The authors report a case of a 77 years old male patient with mild stenosis of the carotid artery caused by an exulcerated plaque in the carotid bifurcation. The patient presented with recurrent ipsilateral strokes which were treated with intravenous thrombolysis. A brief review of the literature related to the management of unstable exulcerated carotid plaque is presented in this article with emphasis on current treatment options. Carotid endarterectomy if often performed in such cases. However, the outcome of the procedure remains still very controversial. In the described case, conservative approach using optimal medical treatment with lipid lowering agents, antiplatelet and antihypertensive therapy was chosen mainly because of patient preference and resulted in favourable outcome.