Background　As aging population builds up, the incidence of perioperative covert stroke rises gradually. With poor prognosis, the perioperative covert stroke is debilitating, and there has no effective intervention and therapy for this disease. 　Objective　This review is to summarize the risk factors and advances in perioperative covert stroke in recent years.　Content　Aging and carotid atherosclerosis are among the risk factors of covert stroke. Covert stroke is commonly seen in perioperative period with a higher incidence(between 10% and 44%) in patients received major cardiac and cerebrovascular surgery than those received non-cardiac and non-cerebrovascular surgery (≤10%). Additionally, adrenoceptor agents taken by patients affect the incidence of covert stroke. The occurrence of covert stroke increases risk of postoperative cognitive dysfunction.　Trend　The afore-mentioned risk factors of perioperative covert stroke need to be confirmed by further investigations in order to guide the prevention and treatment of this disease.