Objective By combining a high fat diet with balloon injury to the left carotid artery, a carotid atherosclerosis (CAS) model in Tibetan miniature pigs was established, and hematobiochemical, imaging, and pathological features of the CAS model were analyzed. Methods Ten male Tibetan miniature pigs were randomly divided into two groups, one of which received a normal diet, whereas the other had an balloon injury to the left carotid artery after 2 weeks while being fed a high fat diet. The modeling period was 12 weeks. Body weight and blood biochemical indexes were measured before high fat feeding (-2 weeks) and balloon injury (0 weeks) and after 2, 6, and 10 weeks. Ultrasound, Doppler flow imaging, and angiography were performed at 10 weeks after the operation. To investigate morphology, inflammation, fibrosis, and lipid deposition, and lesion characteristics of Tibetan mini-pigs, the left carotid artery of the animals was stained with HE, Masson, and oil red O after euthanasia. Results Numerous blood biochemical parameters in the CAS model were similar to the clinical parameters. Imaging findings revealed significant narrowing and increased resistance of the left carotid artery in the CAS model. Resultsing in reduced blood flow velocity. Pathological observations revealed significant inflammatory cell infiltration, collagen fiber proliferation, vessel wall thickening, and lipid deposition, which were similar to clinical manifestations. Conclusions The CAS model in Tibet miniature pig is a an ideal model to investigate CAS because it is sensitive, stable, and resembles clinical aspects.