Chronic cerebral artery occlusion is an important cause of cerebral ischemic events. Endovascular recanalization is an effective treatment for this condition, but its success depends on appropriate patient selection and assessment. This is a retrospective study that collected patients with chronic cerebral artery occlusion who underwent endovascular recanalization to determine how imaging features from computed tomography angiography - including the extent of internal carotid artery occlusion, the number of calcified vessels, and the degree of calcification in the occluded vessels - affect the success rate of recanalization. A total of 147 patients were included, 103 (70.1%) were successfully recanalized. Lipoprotein(a) (Lp[a]) levels were significantly higher in the failed group (38.40 +/- 34.41 mg/dL) compared to the successful group (22.93 +/- 22.84 mg/dL) (P = .008). Among these patients, 49 underwent preoperative CTA, and 36 (73.5%) achieved successful recanalization. There was no significant association between the number of calcified vessels and the endovascular recanalization rate (P = 1.000). However, patients with a calcification degree >50% had a lower recanalization rate (40%) than those with 50% or less calcification (82.1%, P = .014), and the same result was seen in patients with chronic anterior circulation large artery occlusion (P = .019). In patients with chronic intracranial and extracranial large artery occlusion, the degree of vascular calcification in the occluded vessels significantly influences the success of endovascular recanalization.