Objective <p>To evaluate the feasibility and internal consistency of a sequential dynamic contrast-enhanced ultrasound protocol combining wash-in/wash-out and destruction–replenishment analyses for the assessment of intraplaque contrast enhancement in symptomatic patients with moderate carotid stenosis.</p> Methods <p>This retrospective single-center study included 38 symptomatic patients with ipsilateral internal carotid artery (ICA) stenosis of 50–69% who underwent carotid contrast-enhanced ultrasound with a consistent acquisition approach. Dynamic analysis was performed sequentially using wash-in/wash-out and destruction–replenishment techniques. Plaques were classified according to the presence of reproducible intraplaque contrast enhancement on contrast-specific imaging. Semi-quantitative parameters were extracted in enhancement-positive plaques when feasible. Agreement between wash-in/wash-out and destruction–replenishment plaque classification was assessed using Cohen’s kappa coefficient.</p> Results <p>Wash-in/wash-out analysis was feasible in 31 of 38 cases (82%), whereas destruction–replenishment analysis was feasible in 37 of 38 cases (97%). At least one technically adequate dynamic assessment was obtained in all patients. Reproducible intraplaque contrast enhancement was identified in 25 of 38 plaques (65.8%). Semi-quantitative analysis was feasible in 20 enhancement-positive plaques using wash-in/wash-out and in all enhancement-positive plaques using destruction–replenishment. Agreement between techniques, assessed in plaques with adequate acquisitions for both methods (<i>n</i> = 30), was good (<i>κ</i> = 0.77; 95% confidence interval, 0.45–0.90).</p> Conclusion <p>A sequential wash-in/wash-out and destruction–replenishment contrast-enhanced ultrasound protocol is feasible in symptomatic patients with moderate ICA stenosis and provides a coherent, signal-based assessment of intraplaque contrast enhancement in routine clinical practice.</p>