Objective To investigate the imaging features of ultrasonography and CT angiography for carotid atherosclerosis (CAS) plaque in patients with ischemic cerebral stroke (ICS). Methods The imaging features of ultrasonography and CT angiography for CAS in 90 ICS patients treated in our hospital from Feb 2016 to Feb 2018 were selected and analyzed. Then the univariate analysis and multivariate Logistic regression analysis were carried. Results The CAS plaquewas positive in 48 of the 90 patients and was negative in 42 patients. kappa test showed that the positive predictive value was 95.7% in the ultrasonography examination and 93.8% in the CT angiography, moreover, the negative predictive value was 93.0% in the ultrasonography examination and 95.2% in the CT angiography (kappa=0.872). The consistency of adjustment indices was 0.942, and the Youden index was 0.871 (kappa>0.75). The three risk factors including diabetes mellitus, hyperlipidemia and age were significantly different (P<0.05). Multivariate logistic regression analysis showed that hyperlipidemia was an independent risk factor for CAS plaques in ICS patients. Conclusion The results of ultrasonography and CT angiography for CAS plaques in ICS patients are identical, and the screening results are accurate. Ultrasound examination is a non-invasive examination, which is inexpensive and safe.