Objective To investigate the effectiveness and safety of endovascular therapies in patients with acute ischemic stroke (AIS).Methods Twenty-one cases were reviewed who had AIS caused by large vessel occlusion and underwent endovascular treatment. Ten cases underwent endovascular therapy after intravenous thrombolysis with alteplase, and 11 cases were treated with direct endovascular therapy. Twelve of the 21 patients were treated with mechanical thrombectomy, three with mechanical thrombectomy combined with stent implantation, three with carotid artery stenting, one with mechanical thrombectomy and intra-arterial thrombolysis, one with mechanical thrombectomy combined with stent implantation and intra-arterial thrombolysis, and one with intra-arterial thrombolysis. The effectiveness and safety were assessed based on intraoperative recanalization status according to the modified Thrombolysis in Cerebral Infarction (mTICI) scale, complications, and the modified Rankin Scale (mRS) score 90 days after operation.Results Among the 21 patients, 18 had anterior circulation stroke, and three had posterior circulation stroke. The mean National Institutes of Health Stroke Scale score was 15.81±6.44. Recanalization (mTICI 2b-3) was achieved in 20 patients. There was one case of intraoperative hemorrhage; after operation, one case suffered massive intracranial hemorrhage, and four cases had asymptomatic mild intracranial hemorrhage; eight cases were affected by postoperative hyperperfusion syndrome, four of whom underwent decompressive craniectomy and five (23.81%) died. Eight patients got a mRS score of 0~2 at 90 days after operation.Conclusions It is safe and effective to take timely and suitable single or multiple endovascular therapies based on careful evaluation in patients with AIS caused by large vessel occlusion.