Hemodynamic depression (HD) after carotid artery stenting (CAS) is a common perioperative complication, mainly presenting as hypotension and bradycardia. Among these manifestations, persistent hypotension is of greater clinical concern and has been associated with increased risks of stroke, myocardial infarction, renal dysfunction, death, and prolonged hospitalization. The occurrence of HD is related to multiple factors, including advanced age, lesion proximity to the carotid bifurcation, plaque calcification, stent radial force, and balloon dilation. Its central mechanism is generally considered to involve mechanical stimulation of carotid sinus baroreceptors, leading to autonomic imbalance characterized by enhanced parasympathetic activity and reduced sympathetic tone. Current management remains largely reactive, relying on postoperative monitoring, fluid administration, and vasopressor therapy, while effective preventive strategies are still lacking. Future studies should move beyond risk-factor identification toward mechanistic clarification, individualized risk stratification, and targeted interventions to improve the perioperative safety of CAS