In the present case–control study we aimed to investigate the association of common carotid arterial (CCA) stiffness with ischaemic stroke (IS) and to determine whether this relationship was independent of conventional risk factors including CCA intima-media thickness (CCA-IMT). CCA distensibility, defined as the change of CCA-diameter during the cardiac cycle, and CCA-IMT were evaluated by means of high-resolution B-mode carotid ultrasound examination in consecutive, first-ever IS patients (n = 193) and in age- and sex-matched control subjects (n = 106). The CCA distensibility (inverse of CCA stiffness) was significantly (P = 0.007) lower in IS (0.353 mm, 95% CI: 0.326–0.379) than in control subjects (0.415 mm, 95% CI: 0.378–0.451) even after adjusting for blood pressure values, diastolic CCA-diameter and height. The multivariate logistic regression procedure selected CCA-IMT and CCA distensibility as the only independent predictor variables of IS. Each 1 SD increase in the CCA-IMT and each 1 SD decrease in the CCA distensibility independently increased the likelihood of IS by 167.0% (OR: 2.67, 95% CI: 1.80–3.96, P < 0.001) and 59.0% (OR: 1.59, 95% CI: 1.22–2.07, P = 0.001) respectively. Increased CCA stiffness is associated with IS independent of conventional risk factors and CCA-IMT. The causal interrelationship between the elastic properties of the CCA and the risk of stroke deserves further investigation by longitudinal studies.