Aim To investigate the image representation of ultrasonography and CT angiography (CTA) for carotid atherosclerosis (CAS) plaque in patients with ischemic cerebral stroke (ICS).Methods Carotid ultrasonography and CTA data were retrospectively analyzed in 575 patients with ICS from June 2013 to June 2015. The results of the two inspection methods were compared. ICS CAS plaque related risk factors were analyzed. Single factor and multi-factor analysis were applied for the related risk factors. Results The results of carotid ultrasonography and CTA were almost identical, and Kappa value was 0.867. Single factor analysis showed that diabetes, hyperlipidemia and age were the risk factors of CAS plaque in patients with ICS (χ²＝46.000, 15.018, 52.613, all P＜0.05). Multi-factor Logistic regression analysis showed that hyperlipidemia was an independent risk factor of CAS in patients with ICS. Conclusions Carotid ultrasonography is of high accuracy, and it is almost identical with CTA results to the CAS plaque screening. Hyperlipidemia is a major risk factor for the formation of CAS plaque. In the daily clinical work, patients with hyperlipidemia should be treated with lipid-lowering therapy and diet control, and then to avoid the occurrence of CAS.