Abstract： Objective To investigate the characteristics of carotid atherosclerosis (CA) in patients with acute ischemic cerebrovascular disease (AICD) and explore the relation between metabolic syndrome (MS) and CA. Methods Color Dopple ultrasound was used to examine the carotid artery of 514 patients with AICD and 300 healthy subjects as control group. The intima-media thickness (IMT) of common carotid artery, carotid plaque index, the occurrence rate of CA and the prevalence of MS were compared between the 2 groups. Patients with AICD were divided into CA group and non-CA group according to the occurrence situation of CA; the prevalence of MS and the correlation between MS and single risk factor were analyzed. Results The prevalence of MS, IMT, carotid plaque index and the occurrence rate of CA in the AICD group were all significantly higher than those in the control group (P<0.05). The prevalence of MS, and the incidence of hypertension and high levels of triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and total cholesterol (TC) in the CA group were significantly increased than those in the non-CA group. After age, gender and smoking adjusted and further adjusted component risk factors of MS, the MS defined by CDS criteria was associated with a 1.81 to 3.96 fold high risk of the CA. The risk of CA in patients with MS accompanied with diabetes was 5.6 times higher than that in patients with MS alone. Conclusion The prevalence of MS and CA in patients with AICD was high. The MS was positively associated with the risk of CA and cooperated with its component risk factors or diabetes to further impact CA.