Background: Carotid artery can be considered as the window to reflect systemic artery atherosclerosis. Nowadays, the evaluation of carotid artery lesions both from the structural and functional aspects in patients with coronary artery disease (CAD) by ultrasonographic imaging is one of the preferable tools. Materials and Methods: Patients with suspected CAD underwent coronary angiography and were assigned to one of four groups (non-CALs, atherosclerosis, single-lesion and multi-lesion) based on the results. Carotid artery intima-media thickness (IMT) and arterial stiffness were investigated by quality intima-media thickness (QIMT) and quality arterial stiffness (QAS) techniques. Univariable and multivariable modeling were used to investigate arterial elasticity predictors of CALs. Area under the receive operating characteristic curve (AUC) was used to evaluate diagnostic accuracy.Results: Carotid IMT and stiffness variables pulse wave velocity (PWV), α, β and compliance coefficient (CC) were statistically different between every two-group comparisons. Multivariable logistic regression analyses demonstrated that the odd ratio (OR) for patients with CALs were 1.73, 1.67, 1.19, 1.23 and 0.56 accordingly as IMT, PWV, α, β and CC were concerned. The OR values were similar with or without. The AUC of IMT, PWV, α, β and CC were 0.9257, 0.8910, 0.8016, 0.9383, 0.8581 with correctly classified rate of 88.16%, 83.77%, 78.07%, 86.84%, and 81.58%, respectively. Conclusions: The ultrasnongraphic variables derived from QIMT and QAS analysis present favorable diagnostic values for patients with CALs. The vascular stiffness changes predicted by QAS variables highlighted the hypothesis that functional impairment might predate structural damages as we can detect.