Objective:To evaluate the distribution characteristics of postinterventional cerebral hyperdensities (PCHDs) in patients with acute anterior circulation large vessel occlusive stroke after interventional therapy using the Alberta Stroke Program Early CT Score (ASPECTS) and to investigate its predictive value for symptomatic intracranial hemorrhage (sICH).Methods:Consecutive patients with acute anterior circulation large vessel occlusive stroke underwent endovascular mechanical thrombectomy (EMT) in the Stroke Center of Dongguan People's Hospital from January 2018 to December 2020 were retrospectively enrolled. The clinical, imaging and follow-up data were collected. The immediate PCHDs-ASPECTS after endovascular therapy were analyzed. Multivariate logistic regression analysis and receiver operator characteristic (ROC) curve were used to investigate its predictive value for sICH. Results:A total of 161 patients were enrolled in the study, including 115 males (71.4%). The baseline National Institutes of Health Stroke Scale (NIHSS) score was 13.6±5.6; 66 patients (41.0%) developed PCHDs and 35 (21.7%) had sICH. The baseline NIHSS score, the proportion of patients with severe stroke, the number of retrieval attempts and the detection rate of PCHDs in the sICH group were significantly higher than those in the non-sICH group, while diffusion weighted imaging-ASPECTS and PCHDs-ASPECTS were significantly lower than those in the non-sICH group (all P<0.05). Multivariate logistic regression analysis showed that PCHDs had a significant independent positive correlation with sICH (odds ratio 6.036, 95% confidence interval 1.45-25.123; P=0.013), and PCHDs-ASPECTS had a significant independent negative correlation with sICH (odds ratio 0.70, 95% confidence interval 0.496-0.992; P=0.045). ROC analysis showed that the area under the curve predicted by PCHDs-ASPECTS was 0.832 ( P<0.05). When its cut-off value was 8 points, the sensitivity and specificity were 74.3% and 83.3% respectively. Conclusions:In patients with acute anterior circulation large vessel occlusive stroke treated with EMT, the immediate postoperative PCHDs is an independent predictor of sICH, and PCHDs-ASPECTS can early predict the risk of sICH after EMT.