Background: Stroke is a global health problem that leads to disability. In 2005, stroke was responsible for 5.7 million (16.6%) deaths, and 87% of these deaths occurred in low-income and middle-income countries. Two-thirds of strokes are ischemic in origin and 50% of these are associated with severe internal carotid artery disease. The underlying predominant cause of carotid artery disease is atherothrombosis. Method: 20 patients with acute ischemic stroke were enrolled in this study. They were diagnosed clinically and radiologically by MRI brain, then referred to us to be assessed by carotid Duplex and carotid MRI. Results: All patients had carotid atheromatous plaques that show more than one criteria of the following, lipid rich necrotic core of the atheromatous plaque (90%), surface ulceration of the plaque (90%), thrombus on top (80%), hemorrhage in plaque (75%), only 35% had more than 90% stenosis of the carotid lumen by plaques. MRI assessment for carotid atheromatous plaques at acute ischemic stroke patients, it was evident that the right carotid arteries (CCA, ICA) were more affected 14 (70%), most of the atheromatous plaques had thin fibrous cap with lipid rich core 18 (90%), ulcerated surface18 (90%), calcification15 (75%), thrombus on top 16 (80%) as well as hemorrhage within the plaque 15 (75%) with statistically significant P value (0.01, 0.0001,  0.0001,  0.04, 0.001,0.04) respectively. Most atheromatous plaques 10 (50%) caused about 70-90 % luminal stenosis with statistically non-significant difference P value 0.4. Conclusion: Carotid duplex and MRI had complementary role in assessment of carotid atheromatous plaques in stroke patients.