Objectives To investigate the association of pericoronary adipose tissue mean attenuation (PCAT(MA)) with coronary artery disease (CAD) characteristics on coronary computed tomography angiography (CCTA). Methods We retrospectively investigated 165 symptomatic patients who underwent third-generation dual-source CCTA at 70kVp: 93 with and 72 without CAD (204 arteries with plaque, 291 without plaque). CCTA was evaluated for presence and characteristics of CAD per artery. PCAT(MA) was measured proximally and across the most severe stenosis. Patient-level, proximal PCAT(MA) was defined as the mean of the proximal PCAT(MA) of the three main coronary arteries. Analyses were performed on patient and vessel level. Results Mean proximal PCAT(MA) was -96.2 +/- 7.1 HU and -95.6 +/- 7.8HU for patients with and without CAD (p = 0.644). In arteries with plaque, proximal and lesion-specific PCAT(MA) was similar (-96.1 +/- 9.6 HU, -95.9 +/- 11.2 HU, p = 0.608). Lesion-specific PCAT(MA) of arteries with plaque (-94.7 HU) differed from proximal PCAT(MA) of arteries without plaque (-97.2 HU, p = 0.015). Minimal stenosis showed higher lesion-specific PCAT(MA) (-94.0 HU) than severe stenosis (-98.5 HU, p = 0.030). Lesion-specific PCAT(MA) of non-calcified, mixed, and calcified plaque was -96.5 HU, -94.6 HU, and -89.9 HU (p = 0.004). Vessel-based total plaque, lipid-rich necrotic core, and calcified plaque burden showed a very weak to moderate correlation with proximal PCAT(MA). Conclusions Lesion-specific PCAT(MA) was higher in arteries with plaque than proximal PCAT(MA) in arteries without plaque. Lesion-specific PCAT(MA) was higher in non-calcified and mixed plaques compared to calcified plaques, and in minimal stenosis compared to severe; proximal PCAT(MA) did not show these relationships. This suggests that lesion-specific PCAT(MA) is related to plaque development and vulnerability.