To explore the effectiveness and safety of endovascular treatment (EVT) in patients with acute anterior circulation large vessel occlusion (ACLVO) and low National Institutes of Health Stroke Scale (NIHSS) scores at different surgical timings, and to evaluate factors affecting prognosis. Methods: A retrospective collection of clinical data from 89 patients with low NIHSS score (≤5) who underwent emergency EVT for ACLVO at Linyi City People’s Hospital Neurology Department from January 2020 to June 2021. Patients were divided into two groups based on their surgical timing: the direct surgery group (42 cases, who received EVT immediately after admission followed by standard medical therapy) and the rescue surgery group (47 cases, who initially received standard medical therapy upon admission and underwent emergency endovascular rescue treatment if symptoms worsened). The clinical data and outcomes of the two groups were compared. According to the modified Rankin Scale (mRS) score at 90 days post-surgery, patients were divided into a good outcome group (70 cases with mRS ≤2) and a poor outcome group (19 cases with mRS ＞2). Univariate and multivariate logistic regression analyses were used to identify factors affecting the prognosis of endovascular treatment in patients with low NIHSS score ACLVO. Results: Successful recanalization was achieved in 94.4% (84/89) of patients, and 78.7% (70/89) had a good functional outcome at 90 days. There were 9 cases of neurological deterioration post-surgery, 3 cases of symptomatic intracranial hemorrhage, and 3 deaths. Compared to the rescue surgery group, the direct surgery group had a significantly higher proportion of good outcomes at 90 days (90.5% v.s. 68.1%, P<0.05). Preoperative low NIHSS score, direct surgical treatment, and high collateral circulation grade were independent predictors of good outcome in EVT for ACLVO patients with low NIHSS scores. Conclusion: EVT may be safe for patients with ACLVO and low NIHSS scores, and early EVT can significantly improve prognosis in these patients.