Background: We evaluated the clinical outcomes of the stability of carotid and femoral arterial plaques and determined by contrast-enhanced ultrasound (CEUS) for accurate prediction of the artery sclerosis type of ischemic stroke in elderly patients. Methods: We analyzed 24 consecutive patients (mean, 66 ± 19) with carotid and femoral arterial plaques within 48 hours from onset. The carotid and femoral arterial plaques were both observed. The patients were divided into two groups: the carotid plaque (CAP) group and the femoral plaque (FAP) group. Each subject was examined using contrast-enhanced ultrasound (CEUS). Relevant data were recorded, and the microvascular distribution of the plaques was analyzed. Results: Data were analyzed using paired t-test. The maximal plaque thickness and intima-media thickness in the CAP and FAP groups were statistically different (P = 0.027, P < 0.001). Quantitative analysis of CEUS revealed that the enhancement of the time to start and the time to peak intensity of the plaques were statistically significant (P < 0.001), although the differences in mean enhanced intensity of the plaques and the area under the curve obtained by the quantitative analysis of CEUS were not statistically different between the groups (P = 0.078 and P = 0.401, respectively). Wilcoxon rank sum test revealed no statistical difference (P = 0.251) between the carotid and femoral arterial plaque ultrasound contrast rating. Conclusions: The carotid and femoral arterial plaques found in the same patient were stable. The stability of femoral arterial plaques may be used to predict the possible onset of arteriosclerotic ischemic stroke.