OBJECTIVE To assess whether an intensive lipid-lowering strategy is more beneficial on atherosclerotic plaque progression in the stroke survivors. METHODS We retrospectively assessed data that was prospectively collected on 106 ischemic stroke patients from one academic stroke center. Patients with various degrees of common carotid artery atherosclerosis were followed for one year. Patients were classified into intensive lipid-lowering therapy (ILLT) group if they achieve low-density lipoprotein cholesterol (LDL-c)<70mg/dL (n=38) and conventional lipid-lowering therapy (CLLT) group if their LDL-c is within 70-120mg/dL (n=68) at end of one year. Carotid ultrasound was performed at baseline lipid-lowering therapy and at one year to characterize the plaques. RESULTS Mean change in atherosclerotic plaque length was -1.4mm (95% CI: [-4.1, 1, 2]; P=0.27) in ILLT and 1.1mm in CLLP group (95% CI: [-0.9, 3.1]; P=0.27); no difference between groups (P=0.40). Atherosclerotic plaque thickness decreased by 0.2mm (95% CI: [-0.4, 0.03]; P=0.09) in ILLT group; while in CLLT group, thickness increased by 0.02mm after 1-year therapy (95%CI: [-0.1, 0.2]; P=0.77); no difference between groups (P=0.28). CONCLUSIONS Achieving LDL-c<70mg/dL in ischemic stroke patients was associated with a trend of reducing atherosclerotic plaque progression at one year. Future larger studies are warranted.