Objectives- This study analyzed carotid artery remodeling characteristics in early carotid atherosclerosis (ECAS). Methods- The 1021 participants were evaluated using ultrasonography and categorized into three groups: Group A, 391 participants with increased intima-media thickness (IMT); Group B, 300 participants with atherosclerotic plaque only on the carotid bulb (CB); and the control group (330 participants). The ratios of the diameters in the CB to those in the common carotid artery (D-CCA) and internal carotid artery (D-ICA) were defined as carotid index1 (CI1) and 2 (CI2 ). Results- Group A had a higher D-CCA, D-CB, and CI(2 )than the controls (P < .05). Group B had a smaller D-CB, CI1, and CI(2 )than Group A, and higher D(CCA )and smaller CI(1)than the controls (P < .05). Logistic regression showed that CI(2 )was a positive influencing factor for increased IMT (OR: 3.42, 95% CI: 1.74-6.70, P < .001), and CI(1 )was a negative independent factor for CB plaque formation (OR: 0.11, 95% CI: 0.04-0.28, P < .001). Multiple linear regression showed that only in Group B, the vessel side had a significant influence on CI1 (beta = 0.055, P < .05), while age, sex, body mass index, and cerebrovascular risk factors had no significant correlation with CI. Conclusions- The CB and common carotid artery showed positive remodeling with increased IMT, however, the CB showed negative remodeling with plaque formation. CI changes were consistent with CB remodeling. CI was an independent influencing factor for ECAS, and it was only affected by vessel side, providing an objective predictive parameter for ECAS.