〔Abstract〕 Objective To assess the risk factors for symptomatic intracranial hemorrhage (sICH) after endovascular therapy (EVT) in patients with acute anterior circulation large vessel occlusion. Methods A retrospective analysis was used to analyze the clinical data of 273 AIS patients with EVT, of which 158 were male and 115 were female; ages ranged from 33 to 94 years old [71 (59, 78) years old], and sICH occurred in 61 cases. The patients' gender, age, history of smoking and alcohol consumption, history of illness, history of oral anticoagulant/anti-antibiotic administration, oral anticoagulant/antiplatelet medication status, intravenous thrombolytic therapy, admission blood pressure, hospitalization days, occlusion location, procedure duration, number of times of thrombus retrieval, cause of stroke (TOAST classification), revascularization status (mTICI ≥2b), and admission ASPECT score, admission APACHEII score, and admission NHISS score were collected. Univariate analysis was used to compare the differences in the above indicators between the non-SICH group and the sICH group. Multivariable Logistic regression analysis was used to evaluate the independent factors for the occurrence of sICH after EVT. Results The results of univariate analysis showed that mTICI ≥ 2b, admission ASPECT score, and post-EVT sICH were significantly negatively correlated ( P<0.05), while occlusion location (ICA), admission APACHE-II score, admission NHISS score > 20, and admission mRS score were significantly positively correlated with post-EVT sICH ( P<0.05). The results of the multivariable Logistic regression analysis indicated that mTICI≥2b ( OR = 0.314, 95% CI0.106-0.929) and admission ASPECT score ( OR=0.775, 95% CI0.604-0.995) are protective factors for sICH after EVT, while occlusion location (ICA) ( OR=2.047, 95% CI1.033-4.054) and admission APACHE-II score ( OR=1.236, 95% CI1.140-1.340) were risk factors for sICH after EVT. Conclusion Higher admission APACHEII score, lower admission ASPECT score, occlusion location (ICA), and mTICI<2b are independent risk factors for the development of sICH after EVT in patients with acute anterior circulation large vessel occlusion.