Stroke is the second leading cause of death and third leading cause of disability which is associated with many risk factors. The progression of Carotid Intima Media Thickness (CIMT) has been established as a strong predictor of future vascular events recently. The purpose of this study was to assess the association between CIMT and acute ischemic stroke. This cross sectional comparative study was conducted in the Department of Neurology and Medicine, at Mymensingh Medical College Hospital, Bangladesh from January 2019 to September 2020. Total 120 patients (60 cases of acute ischemic stroke and 60 age and sex matched apparently healthy controls) were included in the study. Participants were studied for the presence of atherosclerotic risk factors and CIMT by high resolution ultrasonography. Mean age of the patients with acute ischemic stroke was 62.85±9.30 years and 70.0% were male. No significant difference was noted between cases and controls in terms of age, sex, occupation, education and socioeconomic class. The mean right CIMT in the patient group was 0.94±0.24mm and it was 0.66±0.19mm in the control group (p<0.001). The mean left CIMT in the patient group was 0.97±0.30mm and it was 0.63±0.18mm in the control group (p<0.001). The average CIMT in the patient group was 0.96±0.23mm and it was 0.65±0.17mm in the control group (p<0.001). CIMT was found to be higher among acute ischemic stroke patients who were smoker and hypertensive than that of nonsmoker and normotensive stroke patients. On multivariate analysis, CIMT remained associated with ischemic stroke as compared to other variables {OR 4.53, 95% CI 1.57-13.05), p<0.01}. CIMT measurements are independent markers of acute ischemic stroke.