Patients with internal carotid artery occlusion (ICAO) were followed up for 5 years to observe prognosis and analyze patient risk factors. Methods: We collected the clinical data of 71 patients diagnosed with ICAO. Patients received telephone follow-up for 5 years. According to the Modified Rankin Scale (mRS), patients were divided into the good prognosis group (mRS≤2) and poor prognosis group (mRS＞2). Analysis was performed to evaluate the association between certain biomarkers and prognosis. Results: There were 48 cases (67.60%) in the good prognosis group and 23 cases (32.29%) in the poor prognosis group after the 5-year follow-up. Patients who adhered to oral antiplatelet drugs (aspirin/clopidogrel) and oral statin had a better prognosis, while patients with atrial fibrillation, prior stroke history, high homocysteine (HCY), and high cholesterol (TC) had a poorer prognosis, with statistical differences between the two groups (P<0.05). Logistic regression analysis showed that oral antiplatelet drugs (aspirin/clopidogrel), atrial fibrillation, and HCY and TC levels were correlated with prognosis in ICAO patients (P<0.05). Conclusion: The overall prognosis of ICAO patients at 5 years was good. ICAO patients who adhered to oral antiplatelet drugs (aspirin/clopidogrel) had a better prognosis, while those with atrial fibrillation, high HCY, and high TC had a poorer prognosis.