Objective To discuss the clinical value of flat head CT of two-way digital flat angiography system(DSA)in predicting symptomatic intracranial hemorrhage in patients with acute anterior circulation-large vessel occlusion cerebral infarction occurring within 24 hours after operation.Methods A total of 264 patients with acute anterior circulation-large vessel occlusion cerebral infarction,who were admitted to the Shanghai Changhai hospital to receive treatment from January 2020 to January 2023,were selected for this study.Mechanical thrombectomy was carried out in all the patients,and DSA flat head CT examination was performed 24 hours after operation.According to whether the postoperative DSA plate head CT scan showed high-density shadow or not,the patients were divided into observation group(showing high-density shadow,n=176)and control group(showing no high-density shadow,n=88).The clinical data,therapeutic regimen,and intracranial hemorrhage within 24 hours after operation were compared between the two groups.Taking head CT results as the standard,the clinical value of DSA flat head CT scan performed immediately after operation in predicting symptomatic intracranial hemorrhage occurring within 24 hours after operation was evaluated.Results Among the 264 patients with acute anterior circulation-large vessel occlusion cerebral infarction,118 patients developed intracranial hemorrhage within 24 hours after operation,including 24 patients(20.34％)having symptomatic intracranial hemorrhage.No statistically significant differences in clinical data and therapeutic regimen existed between the two groups(P＞0.05).The sensitivity,specificity and accuracy of DSA flat head CT scan performed immediately after operation in predicting intracranial hemorrhage occurring within 24 hours after operation in the observation group were 97.46％,58.22％and 75.76％respectively.The detection rate of symptomatic intracranial hemorrhage occurring within 24 hours after operation in the observation group was higher than that in the control group,the difference between the two groups were statistically significant(P＜0.05).The sensitivity,specificity and accuracy of DSA flat head CT scan performed immediately after operation in predicting symptomatic intracranial hemorrhage occurring within 24 hours after operation were 87.50％,57.48％and 40.15％respectively.The sensitivity,specificity and accuracy of DSA flat head CT scan in predicting the transformation of cerebral hemorrhage were 95.67％,63.12％and 80.23％respectively.Conclusion In patients with acute anterior circulation-large vessel occlusion cerebral infarction,who develop intracranial hemorrhage within 24 hours after mechanical thrombectomy,DSA flat head CT scan performed immediately after operation often shows high-density shadow,which is very helpful in predicting the risk of postoperative intracranial hemorrhage,the clinicians should make an early diagnosis and response to a possible symptomatic intracranial hemorrhage.