Acute ischemic stroke is a major disease threatening the life and health of middle-aged and elderly people, and intravascular therapy is the most rapid and effective treatment for acute ischemic stroke. However, clinical findings showed that patients who were often treated intravascular within the time window or beyond the time window could not achieve functional independence for 90 days after vascular recanalization, that is, ineffective recanalization. Ineffective recanalization seriously affects the efficacy of intravascular therapy and has become the focus of clinical research by neurologists. In this paper, the mechanism and influencing factors of ineffective recanalization in acute large vascular occlusive ischemic stroke in recent years, as well as possible ways to reduce its occurrence, are comprehensively reviewed, providing references for clinicians to develop more reasonable and perfect programs.