Microplastics (MPs) contamination raises concerns about their impact on human health, particularly cardiovascular diseases. This study investigated the blood MPs levels in patients with extracranial artery stenosis (ECAS) and their possible link to disease severity. 20 ECAS and 10 control patients were recruited. Blood samples, collected before the digital subtract angiography (DSA) procedure, were analyzed by pyrolysis-gas chromatography mass spectrometry (Py-GC/MS), laser direct infrared (LDIR) spectroscopy, and scanning electron microscopy (SEM). Demographic and clinical information was also examined. Strict quality controls were implemented to prevent contamination. MPs were detected by Py-GC/MS in all blood samples, with concentrations significantly higher in ECAS group compared to control (174.89 ± 24.95 vs 79.82 ± 31.73 μg/g, p < 0.001), and polyvinyl chloride (PVC) and polyamide 66 (PA66) were the most abundant among the detected polymers. Further analyses suggested that higher concentrations of MPs may be associated with more severe artery stenosis (p < 0.001). Compared with the normal group, ECAS group had a higher level of D-dimer (0.61 ± 0.6 μg/L vs 0.28 ± 0.09 μg/L, p < 0.05) and longer Thrombin Time (sec) (18.30 ± 3.43 μg/L vs 16.25 ± 1.74 μg/L, p < 0.05). Additionally, LDIR and SEM detected the shape and physical properties of the MPs. In this study, we revealed significant higher blood MPs levels in ECAS patients, with a notable correlation between MPs concentrations and arterial stenosis severity.