Objective To investigate the recanalization techniques for acute ischemic stroke with large vessel occlusion (AIS-LVO) caused by intracranial atherosclerotic stenosis (ICAS) and their clinical efficacy.Methods A total of 264 patients with AIS-LVO caused by ICAS who underwent endovascular treatment in Neurovascular Center, Department of Neurosurgery, the First People's Hospital of Changzhou (the Third Affiliated Hospital of Soochow University) from Jan. 2019 to Mar. 2021 were retrospectively included. All of them were treated with at least 1 method such as mechanical thrombectomy, ADAPT (a direct aspiration first-pass technique) technology, balloon dilatation and/or stent implantation within 6 or 8 h after onset. The clinical data analyzed included age, gender, past history, vessel occlusion site, collateral circulation, intervention methods, immediate postoperative recanalization (modified thrombolysis in cerebral infarction[mTICI]grade ≥ 2b indicated successful recanalization), National Institutes of Health stroke scale (NIHSS) score on admission and at discharge, and prognosis 90 d after operation (modified Rankin scale score ≤ 2 indicated good prognosis).Results Among 264 patients with AIS-LVO caused by ICAS, 229 had anterior circulation lesions and 35 had posterior circulation lesions, with NIHSS scores of 16 (12, 19) and 25 (22, 32) on admission and 8 (6, 11) and 10 (8, 12) at discharge, respectively. The immediate postoperative successful recanalization rate was 91.3% (241/264), including 68 (25.8%) patients with mTICI grade 2b and 173 (65.5%) with grade 3. The incidence of symptomatic intracranial hemorrhage 24 h after operation was 9.1% (24/264). The good prognosis rate was 55.7% (147/264) 90 d after operation, and the mortality was 10.6% (28/264). One hundred and thirty-two patients underwent mechanical thrombectomy alone and 108 patients were treated with mechanical thrombectomy+rescue stenting, and the good prognosis rates 90 d after operation were 58.3% (77/132) and 50.9% (55/108), respectively; there were no significant differences in the baseline data (such as age and gender), immediate postoperative successful recanalization rate or good prognosis rate 90 d after operation between the 2 groups (all P>0.05).Conclusion For patients with AIS-LVO caused by ICAS, mechanical thrombectomy can be the preferred endovascular treatment technique, and rescue techniques such as balloon dilatation and stent implantation are safe and effective.