OBJECTIVE Nesfatin-1 is a novel anorectic neuropeptide with potent metabolic regulatory effects. Nesfatin-1 regulates blood pressure, heart rate, cardiomyocyte metabolism, and permeability. We aimed to evaluate the relationship between carotid artery stenosis (CAS) and nesfatin-1. METHODS Three groups were established as patients with no atherosclerotic plaques (n = 60), CAS <60% (n = 60), and CAS ≥60% (n = 60). Then, patients with CAS were divided into 2 subgroups as patients with calcific (n = 67) and non-calcific (n = 53) carotid artery stenosis according to plaque morphological features. Nesfatin-1 levels and baseline data were compared between groups. RESULTS Serum nesfatin-1 levels were higher in the control group than CAS <60% group (p < .001). Serum nesfatin-1 levels were also higher in CAS <60% group than CAS ≥60% group (p < .001). Multivariable logistic regression analyses demonstrated that serum nesfatin-1 levels were independently associated with CAS. In addition, nesfatin-1 levels were higher in calcific plaques. CONCLUSIONS Nesfatin-1 levels are inversely associated with severtiy of CAS and plaque morphology.