We looked for risk factors for significant carotid stenosis (CS) in patients with ischemic stroke. We included all patients treated for an ischemic stroke/transient ischemic attack (TIA) and had a carotid duplex done from August 2006 to November 2008. A total of 458 patients were included. Significant CS of the extracranial internal carotid artery and the common carotid artery were found in 10.9% (50 of 458 patients). Age (≥65 years old) was the independent risk factor for CS (OR 4.0, P < .0001). The patients with a CS had more history of coronary artery disease (12% vs 8%, P = .32), prior ischemic stroke (18% vs 11%, P = .17), atrial fibrillation (10% vs 5%, P = .19), and smoking (28% vs 24%, P = .18) compared with the patients without CS. The evaluation of the carotid arteries should be recommended in patients with ischemic stroke/TIA, especially in the older ones (≥65 years old).