Asymptomatic carotid atherosclerotic stenosis is a risk factor of ipsilateral ischemic cerebrovascular events. However, the treatments for asymptomatic carotid atherosclerotic stenosis are still controversial, for the medical practice contradicts with the clinical evidence. Hence, it is necessary to access the stroke risk of asymptomatic carotid atherosclerotic stenosis patients and choose vulnerable plaques for surgical intervention to improve the effectiveness of treatment. This review briefly summarizes the epidemiology and research progress on the treatment, stroke risk assessment and underlying intervention indications of asymptomatic carotid atherosclerotic stenosis, aiming to reduce unnecessary interventions and prevent stroke more effectively.