ObjectiveSummarize advances in risk assessment and treatment of asymptomatic carotid artery stenosis and provide a reference for risk-stratified management and therapeutic decision-making. MethodsA systematic literature review was conducted based on studies of asymptomatic carotid artery stenosis both at home and abroad. ResultsThe management of asymptomatic carotid artery stenosis is shifting from reliance on the degree of stenosis alone to multidimensional assessment integrating clinical characteristics, plaque vulnerability, hemodynamic parameters and biomarkers. Best medical treatment is the cornerstone of treatment for all patients and should be continuously optimized through antiplatelet therapy, stepwise lipid-lowering therapy, risk factor control and lifestyle intervention. In patients with high-risk features for stroke or sufficiently long life expectancy and acceptable perioperative risk, carotid revascularization may be considered based on best medical treatment. At present, there are three main methods for carotid revascularization: carotid endarterectomy has the sufficient evidence in evidence-based medicine, transfemoral carotid artery stenting and transcarotid artery revascularization can be used to treat selected patients. Clinical management should follow a closed-loop pathway of assessment, treatment, and follow-up, incorporating multidisciplinary evaluation and shared decision-making. ConclusionsThe management of asymptomatic carotid artery stenosis should be based on best medical treatment, and individualized guided by multidimensional risk stratification. Future research should focus on developing risk-prediction and procedural decision-making tools apply to Chinese population and strengthening prospective studies and long-term follow-up.