Objective To investigate the detection rate of carotid plaque using a color Doppler ultrasound diagnostic apparatus in elderly patients with acute ischemic stroke （AIS）， as well as the high-risk factors for carotid plaque and its association with stroke recurrence.Methods A total of 236 elderly patients with first-episode ischemic stroke who were admitted within 72 hours and were hospitalized in the Department of Neurology and Department of Geriatrics， First People's Hospital of Changzhou， from January to June， 2020， were included. According to the results of carotid artery sonography， they were divided into carotid plaque group with 199 patients and non-carotid plaque group with 37 patients. The two groups were analyzed in terms of clinical data and stroke recurrence after 1.5 years of follow-up.Results The detection rate of carotid plaque was 84.3% in the elderly patients with AIS. The detection rate of carotid plaque in the patients aged 60-69 years， 70-79 years， and ≥80 years was 74.7%， 86.9%， and 96.0%， respectively， suggesting that the detection rate of caro-tid plaque tended to increase with age. Compared with the non-carotid plaque group， the carotid group had a significantly higher proportion of female patients or the patients with a history of hypertension and diabetes （P<0.05）. There was a significant difference in the incidence rate of stroke recurrence events between the carotid plaque group and the non-carotid plaque group （P=0.042）. The multivariate logistic regression analysis showed that age ［odds ratio （OR）=1.070， 95% confidence interval （CI）： 1.02-1.122， P=0.005］， diabetes （OR=2.262， 95%CI： 1.055-4.850， P=0.036）， and carotid plaque （OR=8.128， 95%CI： 1.077-61.348， P=0.042） were independent influencing factors for stroke recurrence.Conclusions There is a high detection rate of carotid plaque in elderly patients with AIS. Age， sex， hypertension， and diabetes are risk factors for carotid atherosclerosis， and age， diabetes， and carotid plaque are associated with stroke recurrence events.