To analyze the influencing factors of poor prognosis after endovascular treatment (EVT) in patients with acute large vessel occlusive ischemic stroke. Methods: The data of patients with acute large vessel occlusive ischemic stroke treated with EVT in the stroke center of Shanxi Baixuen Hospital from June 2020 to December 2022 were retrospectively analyzed. According to the modified Rankin Scale (mRS) at 90 days after surgery, the patients were divided into good prognosis group (mRS 0-2 points) and poor prognosis group (mRS 3-6 points); according to whether the patient died during the follow-up period, the patients were divided into survival group and death group; respectively, compare the demographic data, surgical related indicators and follow-up outcomes of the two groups, and use multifactorial Logistic regression analysis to analyze the influencing factors of poor prognosis after EVT in patients with acute large vessel occlusive ischemic stroke. Re? sults: A total of 150 patients were enrolled in this study, including 92 cases in the good prognosis group (61.33% ) and 58 cases in the poor prognosis group (38.67% ); 129 cases (86.00% ) survived and 21 cases (14.00% ) died. The results of Logistic regression analysis showed that low admission ASPECT score (OR= 0.575, 95%CI 0.391～0.844, P=0.005) and hemorrhagic transformation (OR=4.349, 95%CI 1.032～18.329, P=0.045) were risk factors for poor prognosis; age increase (OR=1.054, 95% CI 1.003～1.108, P=0.038), previous history of atrial fibrillation (OR=3.856, 95% CI 1.111～13.378, P=0.033), direct aspiration during surgery (OR=7.562, 95%CI 2.314～24.715, P=0.001) and hemorrhagic transformation (OR=12.112, 95%CI 2.269～64.649, P=0.004) were risk factors for death after EVT in patients with acute large vessel occlusive ischemic stroke. Conclusion: Low admission ASPECT score and hemorrhagic transformation are risk factors for poor prognosis after EVT in patients with acute large vessel occlusive ischemic stroke. Age increase, previous history of atrial fibrillation, direct aspiration during surgery and hemorrhagic transformation are risk factors for death after EVT in patients with acute large vessel occlusive ischemic stroke.