Acute ischemic stroke (AIS) is the leading cause of adult mortality and disability in China and its treatment lies in rapid revascularization. As the key pathological factor in AIS, thrombus characteristics (such as location, length, composition, permeability, and burden) profoundly influence treatment decisions, interventional strategies, and clinical outcomes. This review systematically summarizes recent advances in imaging assessment for AIS thrombi, highlighting the value of CT and MRI in identifying thrombus signs, as well as the role of thrombus evaluation in differentiating stroke etiology and predicting responses to intravenous thrombolysis and mechanical thrombectomy. It also prospects the promising potential of radiomics and deep learning in characterizing thrombus heterogeneity and developing predictive models. Ultimately, we propose that modern imaging, through multimodal and multiscale refined assessment, is shifting AIS treatment from the traditional “time window”-dependent mode to an individualized paradigm centered on “tissue window” and “thrombus characteristics”, thereby serving as a key driver of precision diagnosis and treatment.