To investigate the risk factors of recurrence of ischemic stroke in extreme elderly patients with large artery atherosclerosis (LAA). Methods: One hundred and eighty-two extreme elderly patients with acute ischemic stroke (LAA) were included in the study. According to the follow-up results of 90 days and 1 year, these patients were divided into the recurrent LAA group and the control group, respectively. The risk factors of recurrence of ischemic stroke were analyzed by univariate analysis and Multiariable logistic regression analysis. Results: Within 90 days, unstable plaque (OR=2.015, 95%CI 1.132-3.011, P=0.024) was associated with recurrence of ischemic stroke for extreme elderly patients with LAA. Within one year, diabetes (OR=3.351, 95%CI 1.724-7.816, P=0.007), carotid stenosis severity (OR=2.035, 95%CI I 1.140-3.118, P=0.021) and character of atherosclerotic plaques (OR=2.205, 95%CI 1.545-4.770, P=0.013) were associated with recurrence of ischemic stroke for extreme elderly patients with LAA. Conclusion: For extreme elderly patients with LAA, unstable plaque was the risk factor of early recurrence of ischemic stroke. Diabetes, carotid stenosis severity and character of atherosclerotic plaques were associated with long-term recurrence of ischemic stroke.