B-mode ultrasonography of the carotid artery is a non-invasive, informative and reproducible technique used for the assessment of prevalence and course of atherosclerosis in a variety of clinical conditions. Visualization of intima-media complex, atherosclerotic plaques, rough arterial wall and calcifications of the carotid artery may be useful for the assessment of atherosclerotic burden. The latter was confirmed in a recent consensus statement of the American Society of Echocardiography. Detection of structural changes, such as Menkeber’s sclerosis of the medial layer of the carotid artery, carotid aneurysm may indicate advanced vascular pathology and prompt an appropriate treatment. Ultrasound images of patients with atherosclerotic plaque and Menkeberg’s sclerosis are presented and issues related to clinical significance of the common carotid artery intima-media thickness are discussed.