Carotid artery atherosclerosis is one of the leading causes of stroke. However, due to its insidious onset, balancing the risks and benefits of surgery for asymptomatic patients is challenging. Once it leads to a stroke, it has an extremely high mortality and disability rate. Therefore, an accurate, individualized assessment of carotid atherosclerotic plaque is necessary, combined with personalized treatment using existing therapeutic modalities. This article discusses new findings and advances in risk assessment and treatment modalities for carotid atherosclerosis.