Objective To evaluate the efficacy and safety of endovascular treatment for acute ischemic stroke with large vessel occlusion (AIS-LVO) in the posterior circulation.Methods The data of 82 patients with posterior circulation AIS-LVO who received endovascular treatment in Linyi People's Hospital from Dec. 2019 to Dec. 2020 were retrospectively analyzed. Vascular recanalization was evaluated by modified thrombolysis in cerebral infarction (mTICI) grade, and the mTICI grade ≥ 2b indicated successful vascular recanalization. Modified Rankin scale (mRS) was used to evaluate the prognosis 90 d after operation, and the mRS score ≤ 2 indicated good prognosis and 3-6 indicated poor prognosis. The incidence of symptomatic intracranial hemorrhage (sICH) after operation and mortality 90 d after operation were recorded. Multivariate logistic regression analysis was used to determine the independent influencing factors of the prognosis 90 d after endovascular treatment.Results Totally 71 AIS patients were included, and 61 (85.9%) of them had immediate postoperative mTICI grade ≥ 2b, including 23 grade 2b and 38 grade 3. sICH occurred in 6 (8.5%) patients after operation. Thirty (42.3%) patients had a good prognosis, 41 (57.7%) had a poor prognosis, and 20 (28.2%) died 90 d after operation. Compared with the poor prognosis group, the proportion of patients with drinking and preoperative National Institutes of Health stroke scale (NIHSS) score were significantly lower, the proportion of patients with consciousness before operation and proportion of patients with posterior communicating artery opening were significantly higher, and puncture-to-recanalization time was significantly shorter in the good prognosis group (all P < 0.05). Multivariate logistic regression analysis showed that preoperative NIHSS score (odds ratio[OR]=1.116, 95% confidence interval[CI] 1.010-1.232, P=0.030), puncture-to-recanalization time (OR=1.019, 95% CI 1.005-1.034, P=0.008) and posterior communicating artery opening (OR=0.285, 95% CI 0.103-0.787, P=0.015) were independent influencing factors for prognosis of patients with posterior circulation AIS-LVO 90 d after endovascular treatment.Conclusion Endovascular treatment is safe and effective in patients with posterior circulation AIS-LVO, and it can improve the clinical outcome of some patients.