Objective To explore the application value of RAPID software based on computed tomography perfusion (CTP) in predicting the outcome of anterior circulation acute ischemic stroke patients with endovascular therapy, and to investigate the indicators influencing prognosis of the patients. Methods A retrospective analysis was done on the clinical data of patients with anterior circulation acute ischemic stroke. All patients underwent endovascular treatment in Changhai Hospital of Navy Medical University (Second Military Medical University) between Jan. 2017 and Feb. 2018, completed cerebral CTP examination and had image analysis results by RAPID software, and the postoperative endovascular reperfusion achieved a modified thrombolysis in cerebral infarction (mTICI) grade ≥ 2b. According the modified Rankin scale (mRS) score at 3 months after surgery, the patients were divided into good prognosis (mRS score ≤ 2) and poor prognosis (mRS score>2) groups. The age, National Institutes of Health stroke scale (NIHSS) score on admission and the image analysis results by RAPID software, including the volumes of hypoperfusion of time to maximum > 4 s, > 6 s, > 8 s, > 10 s (V_{Tmax > 4 s}, V_{Tmax > 6 s}, V_{Tmax > 8 s}, V_{Tmax > 10 s}), core volume of necrosis (V_CBF<30%), mismatch volume and the mismatch ratio (MMR), were compared between the two groups. Logistic regression analysis was used to investigate the prognostic predictors and obtain a prediction formula. Receiver operating characteristic (ROC) curve was used to evaluate the prediction value of the prediction formula. Results Totally 137 patients with anterior circulation acute ischemic stroke were included, including 92 patients in the good prognosis group and 45 in poor prognosis group. The age and NIHSS score on admission were significantly lower in the good prognosis group than those in the poor prognosis group (t=-4.21 and -4.06, both P<0.01). Compared with the poor prognosis group, the V_{Tmax > 6 s}, V_{Tmax > 8 s}, V_{Tmax > 10 s} and V_{CBF < 30%} were significantly smaller, and the MMR was significantly lower in the good prognosis group (Z=-3.11, -3.17, -3.38, -4.52 and -3.74, all P<0.01). Logistic regression analysis showed that young and small V_CBF<30% were independent predicting factors of good prognosis (odds ratio[OR]=0.904, 95% confidence interval[CI] 0.860-0.950; OR=0.976, 95% CI 0.964-0.988; both P<0.01). A prediction formula was obtained:Logit (P)=8.454-0.024×V_CBF<30%-0.101×age, and the area under the ROC curve of the prediction formula was 0.786 (95% CI 0.699-0.873, P<0.01). Conclusion The age and V_CBF<30% are independent factors influencing outcome of patients with anterior circulation acute ischemic stroke. RAPID software based on CTP can be used for preoperative screening of patients with anterior circulation acute ischemic stroke suitable for endovascular treatment, which is worthy of clinical promotion.