BACKGROUND: This study analyzes the factors influencing the 90-day prognosis of acute ischemic stroke (AIS) patients after mechanical thrombectomy (MT) and established a multidimensional risk model to predict postoperative 90-day outcomes. METHODS: A retrospective analysis of clinical data was conducted for AIS patients who underwent MT at our hospital. A total of 111 patients who met the inclusion criteria were included in the study. Based on the modified Rankin Scale scores from follow-up records at 3 months postsurgery, the patients were divided into a good prognosis group (88 cases, 79.28%) and a poor prognosis group (23 cases, 20.72%). Receiver operating characteristic curves were plotted using MedCalc software, and area under the curve (AUC) values were calculated to establish a risk prediction model, presented in the form of a nomogram. RESULTS: Logistic regression analysis showed that C-reactive protein (T3) (P <
0.001), National Institutes of Health Stroke Scale score at admission (P = 0.001), and a history of atrial fibrillation (P = 0.004) were independent predictors of poor prognosis, while albumin (T2) (P = 0.008) was a protective factor for the 90-day outcome. The AUC values for these factors were 0.812, 0.760, 0.655, and 0.757, respectively. The AUC value of Normotu was 0.945. Calibration slope = 0.856, calibration-in-the-large ≈ 0, and observed/expected ratio ≈ 1. CONCLUSIONS: Post-MT C-reactive protein levels, National Institutes of Health Stroke Scale score at admission, and a history of atrial fibrillation are significantly associated with poor prognosis in these patients. Moreover, higher levels of endogenous albumin are a protective factor for the 3-month prognosis of AIS patients after MT.