Background: Carotid artery atherosclerosis is one of crucial pathogenetic factors of cerebrovascular disease, such ischemic stroke. The degree of artery stenosis has been regarded as one of the most effective criteria to assess carotid atherosclerotic severity.  Color Doppler ultrasound (CDUS) acts as an easy and noninvasive technique to research the characterization of carotid atherosclerotic lesion through echogenicity, which is referred to as the reflectance of the ultrasound signal. Objective: To evaluate the incidence of extracranial carotid atherosclerosis in patients presenting with ischemic stroke using the noninvasive CDUS. Patients and methods: This was a cohort prospective observational clinical study conducted on a total of 80 patients with ischemic stroke, divided into two groups (no atherosclerosis n=12 and atherosclerotic cases=73). The study was conducted at Mansoura University Emergency Hospital through one year period from December 2018 to December 2019. Results: A statistically significant higher median right carotid artery intimal medial thickness among atherosclerotic than non-atherosclerotic group. A statistically significant higher median right carotid artery intimal medial thickness was detected among atherosclerotic than non-atherosclerotic group with median thickness was 0.82 and 0.515, respectively. Median plaque index was 4 ranging from 1.6 to 5.9 and incidence of left carotid artery stenosis was 78.1%. Conclusion: Multiple risk factors like age, sex and high mean arterial blood pressure are strongly associated with carotid artery atherosclerosis, so we suggest that high risk patients should be screened by Doppler ultrasonography in order to plan out medical and surgical intervention for primary and secondary prevention of ischemic stroke.