Objective: To investigate the effect of surgical treatment and preoperative assessment methods for symptomatic internal carotid artery (ICA) occlusion. Methods: The clinical data of 11 patients with symptomatic ICA occlusion undergoing surgical treatment from January 2010 to March 2016 in Department of Vascular Surgery of Hainan General Hospital were analyzed retrospectively. Of the patients, 2 cases underwent carotid endarterectomy (CEA) and 9 cases underwent CEA plus embolectomy. Before operation, all patients underwent intracranial and cervical CTA and carotid duplex ultrasonography, and some patients underwent head CT perfusion, transcranial Doppler and whole-brain angiography. The perioperative and long-term results of the patients were observed. Results: All patients had unilateral ICA occlusion, and 4 cases of them had a less than 50% diameter stenosis in the contralateral ICA. Occlusion was mainly located in the initial segment of ICA, and occlusive lesion extended to the skull base in 8 cases, and the length of occlusion ranged from 16 to 85 mm. The blood flow of ICA was detected in the skull base by color Doppler ultrasound in all patients before operation. Recanalization was successfully achieved in 10 patients and failed in 1 case. After operation, the symptoms of cerebral ischemia were significantly relieved in the 10 patients, of whom 3 cases developed hyperperfusion syndrome. During the follow-up period, ICA occlusion occurred in 1 patient at 3 months after operation, and 1 patient died 18 months after operation. Conclusion: For ICA occlusion, surgical treatment offers satisfactory and safe perioperative efficacy as well as good mid- and long-term results. Accurate preoperative assessment is essential for surgical success.