Backround Symptomatic and asymptomatic occlusions of the extracranial internal carotid artery (EICA) is linked with high risk of stroke event. Objective This study aimed to compare symptomatic and asymptomatic occlusion of EICA by carotid duplex ultrasonography (CDU) and determine the risk factors of atherosclerotic plaques and identify the clinical features. Methods This was a hospital based prospective study, conducted at the Third General Central Hospital , between 2015- 2017. Totally, 492 ischemic stroke and complained before symptoms of transient ischemic attack patients aged below and above 50 years of both sexes were included in the CDU study from which 56 cases were determined total EICA occlusions. RESULTS: Of these 56 (11.38%) patients with complete occlusion of EICA, men were predominant (81.6%) with mean age of 58.0±14.8 years and sex ratio 2.5:1. Symptomatic EICA was detected in 49 (87.5%) cases with mean age of 57.5±17.6 while asymptomatic EICA was determined in 7 cases (12.5%) with mean age of 48.3±15.3 years. The most frequent identified risk factors were hypertension (87.5%), smoking (63.6%) and coronary artery disease (69.2%)(p