Carotid artery atheroma may rupture and result in acute thrombotic occlusion or artery-to-artery cerebral embolism. Here, we report a case of internal carotid artery (ICA) occlusion treated emergently by endovascular recanalization and by carotid endarterectomy in the chronic phase. A 62-year-old man was brought to our hospital because of sudden onset of right hemiparesis. His National Institutes of Health Stroke Scale score was 15. Computed tomography (CT) showed no abnormality except for left middle cerebral artery (MCA) hyperdensity. Magnetic resonance imaging with diffusion weighted imaging (MRI-DWI) showed hyperintensity in the left basal ganglia and left frontal lobe, indicating acute ischemia. Neither the left ICA nor the MCA was visible on magnetic resonance angiography. Following intravenous tissue plasminogen activator therapy, endovascular treatment was employed. First, ICA occlusion was treated with a thrombus aspiration device and M1 occlusion was recanalized using a stent-type thrombus retriever. Since the right ICA was reoccluded, balloon angioplasty was additionally performed. Complete recanalization was obtained and the patient recovered completely. Carotid endarterectomy was performed for the residual stenosis three weeks later, preventing hemorrhagic infarction or hyperperfusion syndrome. The postoperative course was uneventful. Endovascular treatment was useful for the acute ICA occlusion and radical surgical treatment was recommended for residual stenosis in the chronic phase.