Background: Coronary arterial remodeling, which is the change in vessel size due to the presence of atherosclerotic lesions, is associated with plaque characteristics and clinical presentation. However, most studies have included patients with distinct levels of coronary artery stenosis. Objectives: The aim of this study was to assess coronary arterial remodeling and its relationship with the plaque features of coronary atherosclerosis determined by intravascular ultrasound (IVUS) in patients with moderate coronary artery stenosis. Methods: In total, 215 patients with lesions with moderate stenosis underwent UVIS imaging. Measurements included minimal lumen area, total artery area, average reference artery area, plaque area, plaque burden, eccentricity index, and remodeling index (RI). RI>1.0 was defined as positive remodeling and RI≤1.0 as negative remodeling. Results: In total, 88 patients had positive remodeling and 127 had negative remodeling. The two types of remodeling did not differ in terms of patient characteristics and risk factors (p>0.05). The acute coronary syndrome was more common in positive remodeling than in negative remodeling (47.7% vs. 8.7%; OR=9.63; 95%CI: 4.56–20.31; p<0.001). The positive and negative remodeling groups differed significantly in the level of stenosis (43.29±18.80% vs. 50.21±14.31%; p=0.003), plaque area (9.40±3.93 mm2 vs. 7.58±3.29 mm2; p<0.001) and plaque burden (68.95±10.38% vs. 63.76±10.27%; p<0.001), but not in lumen area or eccentricity index (p>0.05). Conclusion: Positive vascular remodeling was more prevalent in acute coronary syndrome than instable angina and had a larger plaque area and a higher plaque burden than negative remodeling. Nevertheless, the stenosis level was still lower with positive remodeling.