Objective To investigate relevance between intestinal flora disorder and carotid atherosclerosis by ET. Methods Totally 117 patients with carotid atherosclerosis were selected in hospital from July 2017 to April 2018 as observation group. 117 health checkup people were selected at same period as control group. All people treated echo tracking technique evaluation and intestinal flora detection. Results Stiffness, pressure strain elasticity coefficient, radio wave pressure index, pulse wave conduction velocity, middle intima thickness, streptococcus, staphylococci, enterococci, escherichia coli in observation group were higher than those in control group (P < 0.05). Compliance, bifidobacteria, lactobacillus and yeast in observation group were lower than those in control group (P < 0.05). Carotid atherosclerosis indicators (stiffness, pressure-strain elasticity coefficient, radiation wave pressure index, pulse wave velocity and intima-media thickness) were negatively correlated with intestinal flora (bifidobacterium, lactobacillus, yeast) (P < 0.05), and intestinal flora (digestive streptococcus, staphylococcus, enterococcus, Escherichia coli). There was a positive correlation (P < 0.05). The index of carotid atherosclerosis (compliance) was positively correlated with intestinal flora (bifidobacterium, lactobacillus, yeast) and negatively correlated with intestinal flora (digestive streptococcus, staphylococcus, enterococcus, Escherichia coli) (P < 0.05). Conclusions The clinical value of vascular ET in evaluating carotid atherosclerosis is high, and it is closely related to intestinal flora, which is worthy of clinical application.