Richard Howell had 16 points and 18 rebounds for N.C. State (14-2, 3-0 ACC) in the Wolfpack's first win over in-state rival Duke (15-1, 2-1) in nearly three years.
Scott Wood contributed 14 points and Lorenzo Brown had 12 points and 13 assists.
Seth Curry led Duke with 22 points, including five 3-point conversions. Quinn Cook and Mason Plumlee both scored 15.
North Carolina State led 41-39 at halftime and hit 20-of-23 free throws, including eight in the final minute, to hold the Blue Devils off. Duke was 10-of-12 from the line.