To analyze the factors affecting hemorrhagic transformation (HT) and long-term prognosis of acute ischemic stroke patients after thrombectomy. Methods: 102 patients with anterior circulation thrombectomy and recanalization were enrolled. According to the head CT prompting HT within 24 hours to 1 week after thrombectomy, patients were divided into HT group and NHT group. According to the scores of 1-year modified Rankin Scale (mRS), patients were divided into good prognosis group and poor prognosis group. The clinical data was retrospectively analyzed to find the factors affecting HT and long-term prognosis. Results: Of the 102 patients, 58 cases were included in the HT group, 44 cases in the NHT group and 56 cases in the poor prognosis group, 46 cases in the good prognosis group. Univariate analysis showed that the early Alberta Stroke Program Early CT Score (ASPECTS) in the HT and NHT groups, and in the good prognosis and poor prognosis groups were significantly different (P=0.000, 0.022). Age (P=0.108), coronary heart disease (P=0.061), low-density lipoprotein (LDL) (P=0.078) and preoperative intravenous thrombolysis (P=0.058) may have an impact on postoperative HT. The times of thrombectomy (P=0.118), the time from hospital arrival to puncture (P=0.098) and the time from onset to puncture (P=0.023) may have an impact on the long-term prognosis. Logistic regression analysis showed that the ASPECTS score before thrombus removal is the influencing factor for postoperative HT (P=0.001, OR=0.561, 95% CI 0.393~0.700); the number of thrombectomy (P=0.118), the time from hospital arrival to puncture (P= 0.098) and the time from onset to puncture (P=0.023) may have an impact on the long-term prognosis. The receiver operating characteristic curve (ROC) curve analysis showed that the ASPECTS score before thrombus removal has an effect on the occurrence of HT (AUC=0.736, 95%CI 0.637~0.875, P=0.000) and poor long-term prognosis (AUC=0.630, 95%CI= 0.522~0.734, P=0.025). Conclusion: The ASPECTS score before thrombectomy is an independent risk factor for HT and poor prognosis after thrombectomy. The lower the ASPECTS score, the higher the risk of HT after thrombectomy and the worse the long-term prognosis.