To investigate efficacy and safety of intensive statin therapy in extreme elderly patients with ischemic stroke. Methods: 164 extreme elderly patients with ischemic stroke were randomly divided into groups intensive(atorvastatin 40 mg/d, n=80) and control(atorvastatin 20 mg/d, n=84). The blood lipid level and NIHSS score of the two groups were compared 14 days after treatment. Occurrence of endpoint events and adverse reactions were observed by clinical follow-up survey. Results: 14 days after treatment, there was a significant difference between the two groups in serum low density lipoprotein cholesterol (LDL-C) levels and control rate of LDL-C (P=0.033; P=0.032). There was no difference in NIHSS score (P=0.112). In the 2-year follow-up, mRS and occurrence of total endpoint events in the intensive group were lower than those in the control group (P=0.042; P=0.040). No difference was observed in rates of adverse events (P=0.492). Conclusion: For extreme elderly patients with ischemic stroke, intensive statin therapy can safely and efficiently reduce blood lipid level .