Background: Ischemic stroke is the leading cause of disability and a major cause of mortality worldwide. It is predominantly seen in the elderly and in patients with the metabolic syndrome (MS) [1, 2]. Material and methods: A “case-control” study was performed on 125 subjects with ischemic stroke and on 300 subjects without stroke. After the patients or their relatives signed an informed written consent, according to the declaration of Helsinki, the baseline data was collected by questionnaire. All subjects underwent a complete clinical examination and ultrasound examination of the extracranial carotids. Ischemic stroke diagnostic was made by a neurologist and confirmed by a brain CT scan. MS diagnostic was made according to the diagnostic criteria of the American Cardiology Association (AHA), the National Heart, Lung and Blood Institute (NHLBI) and the International Diabetes Federation (IDF) (2009). Results: Fifty-four percent of patients and 36% of controls had metabolic syndrome criteria according to AHA, NHLBI, IDF (OR: 2.1; CI (1.1, 3.1), p=0.05). The prevalence of atherosclerotic plaques at the level of the extracranial carotid section was significantly higher in patients with stroke compared to the control group (67.2 % vs. 20,0%). Conclusions: In our study generally metabolic syndrome was higher in stroke patients but different components of this syndrome were significantly high either. So management of individual components of the metabolic syndrome is recommended, including lifestyle measures (exercise, appropriate weight loss, proper diet) and pharmacotherapy (medications for BP lowering, lipid lowering, glycemic control, and antiplatelet therapy).