Objective To analyze the predictive value of serum angiopoietin Ⅱ(AngⅡ)and monocyte sur-face Toll like receptor 4(TLR4)levels for the thrombolytic therapy effect and prognosis of patients with is-chemic stroke.Methods The clinical data of 126 patients with ischemic stroke who underwent intravenous thrombolytic therapy in this hospital from January 2021 to August 2024 were retrospectively included.Ac-cording to the therapeutic effect after 4 weeks of thrombolytic therapy,they were divided into the effective group and the ineffective group.Additionally,according to the prognosis after 3 months of treatment,they were divided into the good prognosis group and the poor prognosis group.The levels of serum AngⅡ and TLR4 in all patients after admission were detected.The differences in the levels of serum AngⅡ and TLR4 a-mong patients with different therapeutic effects and different prognostics were compared.Receiver operating characteristic(ROC)curve was used to analyze the thrombolytic effect and prognosis of patients with ische-mic stroke.Results After thrombolytic therapy,the levels of serum AngⅡ and TLR4 in patients with ische-mic stroke increased with the aggravation of neurological deficit(P＜0.05).The levels of serum AngⅡ and TLR4 in the effective group were both lower than those in the ineffective group(P＜0.05).The levels of ser-um AngⅡ and TLR4 in the good prognosis group were both lower than those in the poor prognosis group(P＜0.05).The results of ROC curve analysis showed that the area under the curve for the combined predic-tion of thrombolysis efficacy and prognosis of ischemic stroke by serum AngⅡ and TLR4 was higher than that predicted alone(P＜0.05).Conclusion The levels of serum AngⅡ and TLR4 are closely related to the the thrombolytic therapy effect and prognosis of patients with ischemic stroke.The combined detection of the two has a high predictive value for clinical efficacy and prognosis.