Aim To investigate the effects of butylphthalide combined with edaravone on carotid intima-media thickness (IMT) and neurological function in elderly patients with acute cerebral infarction. Methods From January 2014 to March 6,2 elderly patients with acute cerebral infarction in the Department of Neurology in our hospital were randomly divided into edaravone treatment group and butylphthalide combined edaravone treatment group (combined treatment group), 46 cases in each group. Edaravone treatment group was treated with edaravone, and combined treatment group was treated with edaravone and butylphthalide for 90 days. The therapeutic effects of the two groups were observed, carotid IMT and plaque area were evaluated, and neurological function was evaluated by NIHSS score, modified Rankin scale (mRS) score and Barthel index. At the same time, the occurrence of adverse reactions in the two groups was observed. Results The total effective rate of combined treatment group was significantly higher than that of edaravone treatment group (P＜0.05). After treatment, carotid IMT and plaque area in the two groups were significantly lower than those before treatment (P＜0.05), and significantly lower in the combined treatment group than those in the edaravone treatment group (P＜0.05), the NIHSS score and mRS score in the combined treatment group were lower than those in the edaravone treatment group (P＜0.05), and the Barthel index was significantly higher than that in the edaravone treatment group (P＜0.05), there was no significant difference in the incidence of adverse reactions between the two groups (P＞0.05). Conclusion Butylphthalide combined with edaravone can significantly reduce carotid IMT in elderly patients with acute cerebral infarction and improve their nerve function, the clinical effect is remarkable and the safety is high.