Intravascular plaque usually refers to atherosclerotic plaque. From a clinical point of view, nattokinase has no evidence of dissolving intravascular plaque, and there are no very effective drugs for dissolving intra-arterial plaque. The plaque-dissolving effect of nattokinase currently advertised online needs to be confirmed by clinical studies. Therefore, it is recommended that patients with intravascular plaque actively seek medical attention for targeted systemic treatment and do not believe in excessive propaganda from businesses to avoid delaying their condition. Although nattokinase cannot dissolve plaque, it can help enhance thrombolytic and anticoagulant effects through different pathways, help inhibit platelet coagulation leading to thrombosis, have a supportive role in preventing atherosclerosis, and help improve blood circulation. In addition, nattokinase also has certain anti-hypertensive, hypolipidemic, antioxidant and neuroprotective effects, which are beneficial for patients with cerebrovascular diseases. However, short-term reliance on nattokinase alone usually does not yield significant results, and active medical consultation and treatment are still required. When atherosclerotic plaques are present, if they do not cause significant stenosis, patients can take oral statins to regulate lipid levels and apply anticoagulation and thrombolytic therapy with warfarin and low-molecular heparin under the guidance of a doctor, as well as vasodilatation and cardiac remodeling according to specific conditions. If the narrowing of blood vessels is obvious or even blocked, in addition to drug treatment, interventional therapy and bypass grafting should be used according to the patient’s specific situation to avoid the continuous aggravation of the disease and the negative impact on life safety.