Objective To explore the value of combined non-contrast computed tomography (CT) scan and cerebral CT perfusion imaging in the prognosis evaluation of endovascular treatment for large vessel occlusion of anterior circulation.Methods The clinical data of 151 patients with acute large vessel occlusion of anterior circulation who received endovascular treatment in Qinghai Provincial People's Hospital from May 2016 to May 2020 were retrospectively analyzed. According to the modified Rankin Scale (MRS) score, the patients were divided into the good prognosis group (MRS score: 0 to 2) of 75 cases and the poor prognosis group (MRS score: 3 to 6) of 76 cases. After admission, all patients received non-contrast CT scan combined with CT perfusion imaging, and the imaging parameters including hyperdense middle cerebral artery sign (HMCAS) in the non-contrast CT scan and cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and time to peak (TTP) in the cerebral CT perfusion imaging were recorded. The National Institutes of Health Stroke Scale (NIHSS) score at admission, Alberta Stroke Program Early CT Score (ASPECTS), Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification, collateral blood flow classification, immediate postoperative thrombolysis in cerebral infarction (TICI) classification, and intraoperative and postoperative incidence of symptomatic intracranial hemorrhage were detected. Multivariate Logistic regression was used to analyze the independent influencing factors for the clinical outcome after the endovascular treatment in patients with acute large vessel occlusion of anterior circulation. The application values of HMCAS in the non-contrast CT scan and the aforementioned CT perfusion imaging parameters in the prognosis evaluation of endovascular treatment for large vessel occlusion of anterior circulation were determined.Results The age, the proportion of patients with a history of coronary heart disease and atrial fibrillation, NIHSS score at admission, MTT-ASPECTS score, the proportion of grade 0 to 2 collateral blood flow, the proportion of postoperative TICI less than grade 2b, the number of thrombectomy attempts, systolic blood pressure, and the incidence of HMCAS were lower, and onset-to-reperfusion time, MTT and TTP were shorter in the good prognosis group relative to those in the poor prognosis group, while the CBV-ASPECTS score, CBF and CBV were higher in the good prognosis group than those in the poor prognosis group (P < 0.05). There were no significant differences in gender composition, history of smoking, history of hypertension, history of diabetes mellitus, history of hyperlipidemia, sites of occlusion, TOAST classification, bridging therapy, fasting blood glucose, diastolic blood pressure, creatinine and white blood cell count between the two groups (P > 0.05). Multivariate Logistic regression analysis showed that NIHSS score at admission [O^R = 1.160 (95% CI: 1.019, 1.321)], CBV-ASPECTS score [O^R = 1.789 (95% CI: 1.276, 2.500)], MTT- ASPECTS score [O^R = 2.463 (95% CI: 1.431, 4.239)], collateral blood flow classification [O^R = 5.712 (95% CI: 1.669, 19.549)], onset-to-reperfusion time [O^R= 1.007 (95% CI: 1.002, 1.012)], systolic blood pressure [O^R = 1.032 (95% CI: 1.009, 1.056)], HMCAS [O^R = 1.326 (95% CI: 1.055, 1.667)], CBF [O^R = 0.975 (95% CI: 0.962, 0.988)], CBV [O^R = 1.462 (95% CI: 1.094, 1.954)], MTT [O^R = 1.314 (95% CI: 1.076, 1.605)] and TTP [O^R = 4.460 (95% CI: 1.120, 17.760)] were factors affecting the clinical prognosis after endovascular treatment in patients with acute large vessel occlusion of anterior circulation (P < 0.05).Conclusions In addition to NIHSS score at admission, CBV-ASPECTS score, MTT-ASPECTS score, collateral blood flow classification, onset-to-reperfusion time, and systolic blood pressure, HMCAS in the non-contrast CT scan and CT perfusion imaging parameters including CBF, CBV, MTT and TTP, are also independent influencing factors for the clinical prognosis of patients with acute large vessel occlusion of anterior circulation after endovascular treatment, which should be paid enough attention in clinical practice.