Background <p>The Totaled Health Risks in Vascular Events (THRIVE) score, which ranges from 0 to 9, incorporates factors such as age, the National Institutes of Health Stroke Scale (NIHSS), and the presence of comorbidities including atrial fibrillation, diabetes mellitus, and hypertension. This study aimed to evaluate the predictive value of the THRIVE score on immediate revascularization status following endovascular thrombectomy (IAT).</p> Methods <p>This retrospective cohort study utilized data from the ASSST dataset, covering the period from January 1, 2017, to May 31, 2022. Patients with acute ischemic stroke who underwent IAT were included in this analysis. The association between the THRIVE score and recanalization status—assessed using the Thrombosis in Cerebral Ischemia (TICI) scale (grades 2b/3)—was evaluated employing logistic regression models.</p> Results <p>A total of 485 participants who received IAT were included in the analysis. Our findings revealed that a lower THRIVE score (OR 1.15, 95% CI 1.01–1.30), male sex (OR 1.81, 95% CI 1.15–2.87), and IAT performed following intravenous thrombolysis (OR 1.72, 95% CI 1.08–2.74) were significantly associated with successful revascularization. Youden’s index identified a THRIVE score threshold of &lt; 5 as optimal for predicting outcomes. Patients with a THRIVE score &lt; 5 exhibited a higher likelihood of successful revascularization (OR 1.82, 95% CI 1.10–3.03).</p> Conclusion <p>A lower THRIVE score (&lt; 5) is associated with an increased likelihood of successful revascularization following IAT in patients with acute ischemic stroke, particularly among women.</p>