To explore the efficacy of dexmedetomidine in intravenous anesthesia for endovascular treatment (EVT) of acute anterior circulation ischemic stroke. Methods: A total of 116 patients with acute anterior circulation ischemic stroke treated by EVT in Zhongshan Hospital affiliated to Xiamen University from June 2019 to June 2021 were selected as the research object. The patients were randomly divided into the local anesthesia group (control group) and the local anesthesia combined with intravenous anesthesia of dexmedetomidine injection during operation group (observation group) by using random number table method. The efficacy, complications, S100-β and NIHSS scores were compared between the two groups. Results: The incidence of blood pressure fluctuation, puncture to recanalization time (PRT), radiation exposure time, and thrombectomy times in the observation group were significantly lower than those in the control group (all P< 0.05), and the first recanalization rate was higher than that in the control group (P<0.05). There was no significant difference in SpO2, pulmonary infection, mortality, total recanalization rate and incidence of SICH between the two groups (P>0.05). There was no significant difference in NIHSS score between the two groups before and after surgery (P>0.05), but the proportion of patients with a decrease of NIHSS score ≥8 points in observation group was significantly higher than that in control group (P<0.05). There was no significant difference in S100-β level between the two groups before surgery (P>0.05), but S100-β level in observation group was lower than that in control group at 7 days after surgery (P<0.05). Conclusion: The application of dexmedetomidine in EVT for acute anterior circulation ischemic stroke can improve the curative effect and reduce nerve function damage, which has the advantages of high efficiency and safety.