Perivascular adipose tissue（PVAT）of the carotid artery is a specialized type of adipose tissue closely adjacent to the arterial adventitia，possessing unique anatomical and functional characteristics. Unlike ordinary adipose tissue，PVAT releases a variety of bioactive molecules through endocrine and paracrine mechanisms，interacting with adjacent vascular wall cells and participating in the regulation of local inflammatory responses and vascular homeostasis. The inflammatory status of PVAT is closely associated with the formation，progression，and vulnerability of carotid atherosclerotic plaques，while also playing a critical role in the development and progression of cerebrovascular diseases. In recent years，with the rapid advancement of imaging technologies，non - invasive assessment of PVAT inflammation has become feasible. These techniques provide new tools for early identification of high-risk patients with cerebrovascular diseases and hold promise for optimizing preventive strategies and personalized treatment. This article systematically reviews the pathophysiological mechanisms of carotid PVAT，the latest advances in imaging assessment techniques，and their clinical application value.