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Background: Clinical outcome of internal carotid artery (ICA) occlusion is highly variable and the reason is uncertain. Aim: To study the predictive factors of clinical outcome and stroke recurrence in patients with ischemic stroke associated with unilateral atherosclerosis-related ICA occlusion. Settings and Design: Prospective study in neurology department of a single hospital. Materials and Methods: We prospectively studied 66 patients who suffered from first-ever ischemic stroke associated with unilateral atherosclerosis-related ICA occlusion over a period of two years. The end point was death or stroke recurrence. Statistical Analysis: Chi-square or Fisher's exact test was used to analyze predictors of early functional outcome. Multivariate analysis was used to analyze predictors of death or stroke recurrence within two years. Result: Higher age (=70 years) predicted a worse functional outcome (P = 0.049). Total anterior circulation syndrome (TACS) was associated with a poor functional outcome (P < 0.001), but lacunar syndrome had a better outcome (P = 0.001). Stroke in evolution predicted a poor outcome (P = 0.001), while those with symptom improvement had a better outcome (P = 0.016). Pneumonia predicted a poor outcome (P = 0.021). Five patients expired and 22 patients suffered from recurrent stroke in the following 24 months. Previous transient ischemic attack (TIA) and anemia were associated with a higher risk of death or recurrent stroke within two years (P = 0.036, P = 0.012). Conclusion: High age, TACS, stroke in evolution and pneumonia were predictors for poor functional outcome. Previous TIA and anemia were predictors for death and recurrent stroke within two years. [ABSTRACT FROM AUTHOR]