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Background: Common carotid artery intima-media thickness (IMT) and carotid plaque are established vascular risk factors and are considered to be an early marker of carotid atherosclerosis. In this study, we explore the potential value of carotid IMT and plaques in predicting recurrences in the patients with first-ever ischemic stroke survivors.Methods: During a 40-month period, 584 consecutive patients with first-ever ischemic stroke were recruited. For the definition of recurrent stroke, there had to be either a new neurological deficit or a deterioration of the previous deficit not considered to be due to edema, hemorrhagic transformation or concurrent illness. Most of cases had taken brain imaging repeatedly.Results: We did not found any significant differences of age, gender, body mass index and initial vital sign between the stroke patients with or without recurred. The prevalence of diabetes was higher in the patient with recurrent stroke. Hypertension, dyslipidemia, smoking and infart size were no significant difference. Patients with recurrent stroke had significantly increased carotid IMT values compared to those who did not (0.873 mm vs. 0.798 mm, p=0.002 in right, 0.903 mm vs. 0.826 mm, p=0.002 in left). Carotid plaques were also more found in the patient with recurrence than without recurrence. Carotid IMT (HR=1.74, CI=1.131-2.861, p=0.013 in right, HR=1.613, CI=1.003-2.59 p=0.049 in left) and diabetes (HR 1.730, CI=1.077-2.780, p=0.023) were independent predictors for recurrent stroke in multivariate regression analysis.Conclusions: Carotid IMT is significantly increased and carotid plaque is more frequently found in patients with recurrent ischemic stroke. But, carotid IMT and diabetes, not carotid plaque are independent predictors of recurrence in the patients with ischemic stroke.