To explore rapid predictive biomarkers for early progression and prognosis in acute anterior choroidal artery (AChA) infarction. Methods: A retrospective analysis was conducted on the clinical data of 104 patients with acute AChA infarction. The laboratory indicators, National Institutes of Health Stroke Scale (NIHSS) scores, modified Rankin Scale (mRS) scores, clinical manifestations, and treatment responses were compared between the early progression and non-progression groups, as well as between the good prognosis and poor prognosis groups. Results: The neutrophil-to-lymphocyte ratio (NLR) in the early progression group was higher than that in the non-progression group (P=0.047). The NIHSS scores at admission and discharge, and the mRS scores at discharge in the progression group were significantly higher than those in the non-progression group (all P<0.001). The C-reactive protein (CRP) level in the poor prognosis group was higher than that in the good prognosis group (P=0.034). Patients presenting with hemiplegia as the main manifestation were significantly more prevalent in the progression and poor prognosis groups (P=0.022, 0.021). Ten patients (9.6%) received rt-PA thrombolysis; no bleeding complications occurred, and symptoms improved in all cases. In the progression group, there were no significant differences in discharge NIHSS and mRS scores between the patients treated with argatroban (n=9) and those untreated (n=10) (P=0.431, 0.200), and no bleeding events occurred in either group. Conclusion: NLR may be a potential biomarker for predicting early progression in patients with acute AChA infarction without ipsilateral large vessel disease; CRP may serve as a marker for predicting the short-term prognosis of these patients; early neurological deterioration is an important predictor of short-term prognosis in AChA infarction patients. rt-PA thrombolytic therapy is safe and effective, while argatroban treatment did not significantly improve the short-term prognosis of patients in the progression group.