To discuss the differences in clinical characteristics of patients with acute large vessel occlusion (ALVO) due to large artery atherosclerosis (LAA) or cardioembolism (CE), and to compare the efficacy of endovascular treatment (EVT). Methods: All patients with ALVO who received EVT between May 2018 and July 2022 in the Aerospace Center Hospital National Advanced Stroke Center were included in this retrospective study. Patients were classified into the LAA group and CE group according to the TOAST classification system. Modified Thrombolysis in Cerebral Infarction (mTICI) score was used to evaluate the revascularization status; modified Rankin Scale score (mRS) at 90-day was used to evaluate prognosis; intracranial hemorrhage transformation (HT) within 72 hours after EVT and 90-day mortality were used to evaluate the safety of the surgery. We compared the clinical characteristics, therapeutic efficacy, and the prognosis of two groups after EVT, and explored the independent risk factors for poor prognosis. Results: A total of 184 patients were enrolled in this study; 164 patients were placed in the LAA group (89.1%) and 20 in the CE group (10.9%). Compared to patients in the CE group, those in the LAA group had a significantly younger age (P<0.001), lower baseline National Institutes of Health Stroke Scale (NIHSS) scores (P=0.024), and higher Glasgow coma scale (GCS) scores (P= 0.037). There were statistically significant differences in history of atrial fibrillation (P<0.001), drinking (P= 0.004), D-dimer level (P=0.008), and uric acid level (P=0.038). There were no significant differences in puncture to reperfusion time, recanalization rate, times of thrombectomy and thrombectomy method. Compared to patients in the CE group, those in the LAA group had a significantly higher good prognosis rate (38.4% vs. 10%, P=0.012), lower mortality rate (13.4% vs. 35%, P=0.03), but there was no significant difference in intracranial HT (P=0.522). Multivariate logistic regression analysis showed that age and baseline NIHSS scores were independent risk factors for poor prognosis. Conclusion: LAA ischemic stroke patients have better prognosis and lower mortality than CE patients after EVT. Age and baseline NIHSS scores are independently associated with poor prognosis.