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Background: Duplex ultrasound (DUS) has become one of the main assessing methods for carotid diseases. Duplex ultrasound uses two techniques, traditional B-mode ultrasound and Doppler US. The screening of carotid artery stenosis using ultrasonography is essential for not only daily clinical settings but also management of patients with stiffness in carotid artery through the cross sectional area of the carotid artery. By comparing the people of rural and urban area, we will know about the stiffness caused by pollution. Objective: To compare the Carotid Artery Stiffness in adults belonging to Urban and Rural areas of Punjab by ultrasonography. Methodology: It was cross-sectional analytical study conducted in Department of Diagnostic Radiology, at Nishtar Hospital, Sehat Medical Complex, Lahore. Duration of study was 7 months. Total sample size was 135. Result: In urban areas, the mean RCC stiffness was notably higher at 324.13 compared to the rural population's lower mean of 222.20. Similarly, the LCC stiffness in urban adults exhibited a higher mean of 329.52, while rural adults showed a lower mean of 239.34. The diameter measurements during systole and diastole also displayed variations between urban and rural settings. RCC diameter during diastole showed a statistically significant difference with an urban mean of 0.27 compared to the rural mean of 0.24. Conclusion: Urban populations exhibited significantly higher RCC and LCC stiffness compared to rural counterparts. Additionally, urban individuals demonstrated larger RCC diameters during systole and diastole. [ABSTRACT FROM AUTHOR]