Objective To investigate the predictive value of carotid plaque score and intima-media thickness (IMT) in patients with chronic total occlusion (CTO) of coronary artery. Methods A total of 608 patients who underwent carotid artery ultrasonography and the first coronary angiography in Changhai Hospital of Naval Medical University (Second Military Medical University) were divided into CTO group (150 cases) and non-CTO group (458 cases) according to the results of coronary angiography. Baseline data and carotid artery ultrasonography results were compared between the two groups, and the risk factors of coronary CTO were analyzed by univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curve was drawn to analyze the predictive values of carotid plaque score, IMT and comprehensive predictive variables composed of multiple risk factors for CTO. Results The age, proportion of male sex, body mass index (BMI), proportion of hypertension, serum creatinine level, detection rate of carotid plaque, mean thickness of bilateral carotid plaques, total plaque score and mean IMT in the CTO group were significantly higher than those in the non-CTO group (all P<0.05). Multivariate logistic regression analysis showed that older age, high BMI, high serum creatinine level, high total plaque score and high mean IMT were independent risk factors for CTO (all P<0.05). ROC curve analysis showed that the area under curve (AUC) values (95% confidence interval[CI]) of total plaque score, mean IMT and comprehensive predictive variables (combined parameters of age, BMI, serum creatinine level, total plaque score, and mean IMT) were 0.676 (0.637-0.713), 0.633 (0.593-0.671) and 0.738 (0.701-0.772), respectively. The AUC value of comprehensive predictive variable was significantly different from those of total plaque score and mean IMT (both P<0.05). Conclusion Carotid total plaque score and mean IMT have certain predictive value for coronary artery CTO. The combined parameter of age, BMI, serum creatinine, total plaque score and mean IMT is superior to the two alone in predicting CTO.