Aim To investigate carotid atheroscelerotic lesions in the population ≥ 45 years of age in Dongying area. Methods Carotid artery ultrasound was performed in a total of 10 182 residents aged 45 or above. All residents were selected from 5 districts of Dongying urban and rural areas using cluster random sampling method. The carotid intima-media thickness (IMT), the plaque and vascular stenosis were recorded. Results The overall detection rate of carotid atheroscelerotic lesions was 74.8%, among which, the detection rates of simple IMT thickening, plaque formation, single plaque, multiple plaques, single carotid artery involvement, multiple carotid arteries involvement, carotid artery stent (CAS) implantation, and restenosis post CAS were 20.3%, 55.9%, 20.8%, 33.5% , 21.6%, 53.1%, 0.12%, and 0.03%. The detection rates of carotid artery mild stenosis (<50%), moderate stenosis (50%~69%), severe stenosis and occlusion (70%~100%) were respectively 73.6%, 1.0%, and 0.2%. The prevalence of carotid atheroscelerotic lesions, plaque formation, multiple plaques and multiple carotid arteries involvement in urban population were higher than that in rural population(P<0.05). There were significant differences between rural and urban population in the constituent ratio of carotid artery stenosis(P<0.05). The detection rates of carotid atheroscelerotic lesions, simple IMT thickening, plaque formation, multiple plaques, multiple carotid arteries involvement, and CAS implantation were higher in males than in females(P<0.05). Conclusion The incidence of carotid atherosclerosis in the population of Dongying area is high, the detection rate of the urban population is higher than that in rural population.