Objective To investigate the impact of perioperative blood pressure management on the prognosis of successful recanalization patients with anterior circulatory acute ischemic stroke with large vessel occlusion (AIS-LVO).Methods Consecutive patients with anterior circulation AIS-LVO who achieved successful recanalization (thrombolysis in cerebral infarction grade ≥ 2b) after endovascular treatment (EVT) in Neurovascular Center of our hospital from Mar. 2018 to Jun. 2019 were retrospectively enrolled. The influencing factors of good prognosis (modified Rankin scale score ≤ 2) were analyzed by univariate analysis, and the variables with P < 0.1 were included for multivariate logistic regression analysis to understand the prognostic value of mean systolic blood pressure (mSBP) in the first 24 h after EVT. According to the first 24 h mSBP after EVT, the patients were divided into 3 groups:low mSBP (100- < 120 mmHg[1 mmHg=0.133 kPa]) group, medium mSBP (120-140 mmHg) group and high mSBP (>140-160 mmHg) group. The good prognosis rate and mortality 3 months after EVT and the incidence of symptomatic intracranial hemorrhage (sICH) 24 h after EVT were compared among the 3 groups. Then the patients were divided into low to medium mSBP group (100-140 mmHg) and high mSBP group (>140-160 mmHg) for prognosis analysis.Results A total of 238 patients were included, including 161 (67.65%) with good prognosis and 77 (32.35%) with poor prognosis 3 months after EVT. The age, National Institutes of Health Stroke scale (NIHSS) scores before and 24 h after EVT, preoperative infarction core volume (brain tissue volume of cerebral blood flow < 30%) and first 24 h mSBP after EVT were significantly lower in the good prognosis group than those in the poor prognosis group, while preoperative Alberta Stroke Program early computed tomography score (ASPECTS) was significantly higher than that in the poor prognosis group (all P < 0.05). Multivariate logistic regression analysis showed that the preoperative ASPECTS (odds ratio[OR]=1.338, 95% confidence interval[CI] 1.081-1.657, P=0.007), NIHSS score 24 h after EVT (OR=0.838, 95% CI 0.785-0.894, P < 0.001) and first 24 h mSBP after EVT (OR=0.966, 95% CI 0.937-0.996, P=0.031) were independent prognostic factors. With the increase of mSBP, the mortality 3 months after EVT and the incidence of sICH 24 h after EVT were both significantly increased (P=0.001, 0.032), while the good prognosis rate 3 months after EVT was slightly decreased without significant difference (P=0.060). The good prognosis rate 3 months after EVT was significantly higher in the low to medium mSBP group than that in the high mSBP group (P=0.04), the incidence of sICH 24 h after EVT was significantly lower than that in the high mSBP group (P=0.01), while there was no significant difference in mortality 3 months after EVT between the 2 groups (P=0.19).Conclusion The mSBP in the first 24 h after EVT is an independent prognostic factor for anterior circulation AIS-LVO patients with successful recanalization. Active control of the mSBP ≤ 140 mmHg in the first 24 h after EVT is recommended, and if the risk of hemorrhagic transformation is high, it may be controlled at 120 mmHg or below.