Objective: To investigate the predictive value of the positional correlation between postoperative FLAIR vascular hyperintensity (FVH) and infarct areas in patients with acute ischemic stroke (AIS) for neurological functional outcomes after endovascular thrombectomy (EVT). Methods: A retrospective analysis was performed on the clinical and imaging data of 180 patients with acute ischemic stroke (AIS) who underwent endovascular thrombectomy (EVT) at our center between July 2017 and April 2025. All patients were divided into four groups according to the relationship between diffusion-weighted imaging (DWI) lesions and FLAIR vascular hyperintensity (FVH): Group A (FVH-negative), Group B (FVH located within infarct lesions), Group C (FVH located outside infarct lesions), and Group D (FVH present both inside and outside infarct lesions). Favorable functional prognosis was defined as a modified Rankin Scale (mRS) score of 0-2 at the 90-day follow-up after EVT. Multivariate logistic regression analysis was conducted to establish a prognostic prediction model for patients with anterior circulation large vessel occlusion AIS beyond the time window following EVT. The area under the receiver operating characteristic (ROC) curve (AUC) was calculated to evaluate the predictive efficacy of the model. Results: A total of 180 patients were enrolled in this study, including 56 patients in Group A, 34 in Group B, 63 in Group C, and 27 in Group D. Group C exhibited the lowest rate of favorable prognosis compared with the other groups, while Group B had the highest hemorrhagic transformation rate and the largest final infarct volume (all P < 0.05). Logistic regression analysis demonstrated that baseline NIHSS score on admission, postprocedural NIHSS score, vascular recanalization status, final infarct volume, and the positional relationship between FVH and infarct lesions were independent predictors of functional prognosis after EVT in AIS patients with anterior circulation large vessel occlusion (all P < 0.05). ROC curve analysis revealed that the combined model incorporating all the above independent predictors possessed strong predictive performance for patient prognosis, with an AUC of 0.904, a sensitivity of 83.1%, and a specificity of 83.5%. Conclusion: The positional relationship between postoperative FVH and the infarct core can serve as an effective imaging biomarker for evaluating clinical outcomes in patients with AIS following EVT.