Objective To investigateinfluencing factors of hemorrhage conversion after mechanical thrombolysis in acute large vessel occlusive stroke and establish risk prediction model. Methods A total of 262 cases of acute large-vessel occlusive stroke with concomitant mechanical thrombolysis in Nanchong Central Hospital from July 2020 to November 2023 were included, and they were divided into hemorrhagic group (80 cases) and non-hemorrhagic group (182 cases) according to the immediate postoperative cranial CT and the 24-hour postoperative cranial CT. General, laboratory and surgical data of the 2 groups were counted, and the collected data were analyzed by univariate and multivariate logistic regression analyses and a predictive model was developed to compare the predictive model with the ASIAN model. Results Univariate analysis showed that the differences were statistically significant (P＜0.05) when comparing the parameters of preoperative NIHSS score, preoperative blood pressure, ASPECT score, aspartate aminotransferase (AST), D-dimer, method of bolus extraction, intraoperative tirofiban application, and number of suctioning times; and multifactorial Logistic regression analysis showed that: preoperative NIHSS score (OR=0.905), ASPECT score (OR=3.541), bolus extraction method (Balloon + suction)(OR=3.683), intraoperative tirofiban application (OR=0.147) were independent influencing factors (P＜0.05) for the conversion of intracranial hemorrhage after mechanical embolization in acute large vessel occlusive stroke. The area under the ROC curve of the predictive model was 0.868, there was no significant difference between the predictive model and the ASIAN model. Conclusion Preoperative NIHSS score, ASPECT score, embolization method(Balloon + suction), and intraoperative tirofiban application are independent influences on the conversion of intracranial hemorrhage after mechanical embolization in acute large vessel occlusive stroke