Introduction: Various studies have verified the effectiveness of ESSEN score on predictions for recurrence of stroke. However, there are still no studies of combining ESSEN score with computed tomographic angiography. This study aimed to hierarchically evaluate clinical characteristics of patients with internal carotid artery occlusion (ICAO) by using ESSEN stroke risk score, which may provide evidence for predicting risk for recurrent cerebral stroke with ESSEN score and angiographic findings. Materials and methods: A total of 100 ICAO patients who received computed tomography angiography (CTA) of the head and neck were reviewed. On the basis of ESSEN score, patients were divided into 2 groups: ESSEN >= 3 patients and ESSEN <3 patients. The clinical biochemical findings and concomitant lesions of vertebrobasilar artery and/or other intracranial major arteries were compared between two groups. Results: The plasma homocysteine level in ESSEN >= 3 patients was significantly higher than that in ESSEN <3 patients (P<0.05). ESSEN >= 3 patients were more likely to develop concomitant lesions of the vertebrobasilar artery_(61.67% vs 40.00%, P<0.05). The number of lesions of intracranial major arteries, in ESSEN >= 3 patients was larger than that in <3 points group (P<0.05); the number of affected intracranial major arteries (2 or more arteries) in ESSEN >= 3 patients was larger than that in ESSEN<3 patients (67.80% vs 39.47%, P<0.01). Conclusion: Patients with ESSEN >= 3 were more likely to develop hyperhomocysteinemia and have concomitant lesions of vertebrobasilar artery and lesions of 2 or more intracranial major arteries.