Abstract: Objective: Carotid artery computed tomography angiography (CTA) was used to analyze carotid atherosclerotic plaques and explore the correlation of plaque properties and other factors with the occurrence of acute ischemic stroke. The aim was to provide a basis for the prevention and treatment of acute ischemic stroke. Methods: Patients who underwent carotid artery CTA and magnetic resonance diffusion-weighted imaging (DWI) within 2 weeks before or after carotid artery CTA were analyzed retrospectively. Based on magnetic resonance DWI data, these patients were divided into the acute ischemic stroke group (n=95) and non-acute ischemic stroke group (n=102). The clinical data, laboratory data, and nature and surface morphology of the carotid plaques on CTA were compared between the two groups. Variables with P<0.05 were included in a multivariate logistic regression analysis to determine the risk factors of acute ischemic stroke. Results: Age, hypertension history, and levels of total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), homocysteine (Hcy), cystatin C (Cys-C), and glycated hemoglobin (HbA1c) differed significantly between the two groups. Multivariate regression analysis revealed that age ≥65 years (odds ratio OR: 4.95), hypertension (OR: 9.91), high TC (OR: 2.78), high Hcy (OR: 3.07), high HbA1c (OR: 4.60), and lipid plaque (OR: 4.89) were the independent risk factors for acute ischemic stroke. A high HDL level (OR of 0.13) was identified as a protective factor for the development of acute ischemic stroke. Conclusion: Carotid atherosclerosis is related to acute ischemic stroke occurrence. Furthermore, the presence of lipid plaques is a risk factor for acute ischemic stroke. Combined with some laboratory indicators, carotid artery CTA can judge the nature of carotid plaques and provide a basis for the prevention and treatment of acute ischemic stroke.