In recent years, the morbidity and mortality rates of stroke have been increasing. Stroke is the second leading cause of death and the third leading cause of disability worldwide, whereas carotid artery stenosis (CAS) is one of the important causes of stroke [1]. CAS is categorized into symptomatic stenosis and asymptomatic stenosis, with symptomatic CAS being defined as a stenosis-associated stroke or transient ischemic attack occurring within the past 6 months and asymptomatic CAS including a never-occurring ischemic event or a duration of symptomatic CAS ≥6 months [2]. The risk of future stroke is significantly greater in symptomatic CAS patients compared with asymptomatic CAS patients [3]. Plaque rupture and hemodynamic changes in patients with CAS can lead to stroke [4].In the present study, we combined MR plaque imaging and arterial spin labeling (ASL)-based imaging to assess the degree of stenosis, the Plaque Reporting and Data System (RADS) score, cerebral blood flow (CBF), and arterial transit artifacts (ATAs) in patients with CAS to identify imaging parameters that help to predict symptoms in CAS patients.