〔Abstract〕Objective To analyze the application value of carotid artery color doppler ultrasound in the diagnosis of elderly ischemic stroke. Methods A total of 32 first-onset ischemic stroke in senile patients admitted to the First Affiliated Hospital of Fujian Medical University from January 2019 to December 2020 (observation group) and 32 healthy elderly people who underwent physical examination during the same period (control group) were selected as the research objects. Color doppler ultrasound examination of cervical vessels was performed in both groups. Cervical vascular lumen stenosis, plaque, common carotid intimamedia thickness (IMT) and carotid blood flow parameters were compared between the two groups of study subjects. Results The detection rate of carotid plaque, lumen stenosis and vulnerable plaque in observation group were higher than those in the control group, with statistical significances (P < 0.05). The IMT and blood flow resistance index (RI) in observation group were higher than those in the control group, and the peak systolic velocity (PSV), end diastolic flow velocity (EDV) and lumen diameter of common carotid artery in the observation group were lower than those in the control group,with statistical significances (P < 0.05). Conclusion Carotid artery color doppler ultrasound can not only comprehensively observe the carotid artery plaque formation and lumen stenosis, but also accurately determine the nature of the plaque and hemodynamic changes,which has positive significance for predicting the occurrence of ischemic stroke in the elderly.