Objective To explore the correlation of thrombus pathologic components with clinical features and prognosis of endovascular treatment（ EVT） in patients with acute ischemic stroke（ AIS）. Methods A total of 120 AIS patients admitted to Chongqing University Fuling Hospital for EVT from January 2021 to January 2024 were selected to analyze their postoperative histology of thrombus pathology. Three months after surgery， the patients were categorized into good prognosis group（ 94 cases，mRS≤2） and poor prognosis group（ 26 cases，mRS＞2） according to the modified Rankin Scale（ mRS） score. Logistic regression was used to analyze the correlation between the thrombus pathological components and clinical features and prognosis of EVT. Results There was no significant difference in gender， history of diabetes mellitus， smoking and drinking， interval from onset to admission， scores of NIHSS and Alberta Stroke Program Early CT（ ASPECT） at admission， occlusion sites， thrombectomy frequency or interval from puncture to reflow between the two groups（ all P＞0.05）. The proportions of age ≥65 years， hypertension history and fibrin-rich thrombus in poor prognosis group were higher than those in good prognosis group（ χ2=5.701，10.343，16.094，all P ＜ 0.05）. Logistic regression analysis with prognosis as the dependent variable revealed that age ≥ 65 years， history of hypertension， and fibrin-rich thrombus were risk factors for poor prognosis in patients with AIS， and the difference was statistically significant（ OR=1.168， 1.155， 1.256， all P ＜ 0.05）. Conclusions Age， blood pressure， and thrombus pathologic composition are influencing factors of the prognosis of EVT in patients with AIS.