Abstract: Objective: In this study, we aim to investigate the correlation between carotid artery fat density and atherosclerotic stenosis, providing a clinical reference for the early identification of carotid atherosclerotic stenosis. Methods: A retrospective analysis was conducted on patients with complete clinical data and confirmed diagnoses who underwent carotid computed tomography angiography (CTA) at Panjin Central Hospital between January 2023 and August 2023. A total of 224 blood vessels were included in the study. Patients were divided into a stenosis group and a control group based on the presence or absence of atherosclerosis. The stenosis group was further categorized into mild, moderate, and severe stenosis, and classified into Groups I, II, and III based on age. Additionally, patients were classified into symptomatic and asymptomatic groups based on their symptom status, and the correlation between perivascular fat density (PFD), carotid atherosclerotic stenosis, and cerebrovascular events was explored. Results: Hypertension, hyperlipidemia, and age were significantly associated with carotid atherosclerotic stenosis. PFD increased with the degree of stenosis and age. Correlation analysis revealed a positive correlation between PFD, age, history of hypertension, history of hyperlipidemia, and carotid artery stenosis. The PFD in the symptomatic group was higher than in the asymptomatic group, and the difference remained statistically significant after binary logistic correction for confounding factors. Conclusion: Carotid artery PFD is an independent risk factor for carotid atherosclerotic stenosis. Patients with symptomatic carotid artery stenosis exhibit higher carotid fat density compared to their asymptomatic counterparts.