Acute ischemic stroke has the characteristics of high disability, lethality and recurrence rate, which seriously threatens the health of middle-aged and elderly people. This article describes the acute ischemic stroke with internal carotid artery occlusion as the main clinical feature and discusses its treatment strategy. Treatment remedies: clinical diagnosis was carried out based on the present medical history, physical examination and craniocerebral CT (computed tomography). Neurological function was improved by intravenous thrombolysis, cerebrovascular angiography was used to clarify cerebrovascular occlusion, cerebral blood supply was identified by CT perfusion, and neurological function recovery was followed up. After intravenous thrombolysis, the patient’s consciousness turned clear and the right limb muscle strength recovery was not obvious, but the patient did not receive bridging therapy. Cerebral angiography showed about 90% stenosis at the beginning of the left internal carotid artery, and the blood flow terminated at the C7 segment. Cerebral CT perfusion imaging showed decreased perfusion in the left cerebral hemisphere, but the patient did not receive carotid endarterectomy and vascular bypass treatment. Post treatment evaluating: follow-up showed that NIHSS (National Institute of Health stroke scale) score was significantly decreased and limb function was significantly restored. Conclusion: early intravenous thrombolytic therapy can help reduce the area of ischemic penumbra and improve long-term prognosis. Severe vascular stenosis can stimulate vascular compensation, significantly reduce the range of ischemia when thrombus occurs, and effectively reduce the disability rate without bridging therapy. Whether vascular stenosis and occlusion are treated by vascular bypass, etc., individualized plans should be made according to vascular compensation.